Transmission of Clostridium difficile in hospitals may not be through contact with infected patients

February 7, 2012

Contrary to current convention by which infection with the organism Clostridium difficile is regarded as an infection that is acquired by contact with symptomatic patients known to be infected with C. difficile, these may account for only a minority of new cases of the infection. These findings are important as they indicate that C. difficile infection, which can be fatal especially in older people, may not be effectively controlled by current hospital infection strategies.

In a study led by Professor Tim Peto of the John Radcliffe Hospital in Oxford, UK, and published in this week's , almost 30 000 from nearly 15 000 patients were tested for C. difficile, with 4.4% (n=1282) found to be positive by specialised laboratory tests (enzyme immunoassay and culture). With further tests (genotyping), the researchers identified 69 types of C. difficile and when linking this information to the clinical situation found that the majority of cases of C. difficile infection were not linked to known cases (66%) and only 23% shared the same type of C. difficile as a ward patient known to be infected.

The authors say: "In this endemic setting with well-implemented infection control measures, up to three-quarters of new [C.difficile infections] are not easily explained by conventional assumptions of ward-based from symptomatic patients and so may not be targeted by current interventions."

The authors conclude: "A better understanding of other routes of transmission and reservoirs is needed to determine what other types of control interventions are required to reduce the spread of C. difficile."

However, in an accompanying Perspective article, Stephan Harbarth from the University of Geneva Hospitals and Medical School in Switzerland and Matthew Samore from the University of Utah School of Medicine in Salt Lake City, USA (uninvolved in the research study) note that given the methods used in the study, the research cannot definitively answer some important clinical questions, such as the amount of benefit accrued by blocking transmission from symptomatic C. difficile cases and the proportion of the C. difficile infections that are attributed to within-hospital transmission that actually represent already-infected individuals who come into the hospital. Harbarth and Samore say: "The study by Sarah Walker and colleagues cannot provide definitive answers to these questions because it has significant limitations with respect to both issues." These authors recommend that more studies be conducted to fully answer these questions.

More information: Walker AS, Eyre DW, Wyllie DH, Dingle KE, Harding RM, et al. (2012) Characterisation of Clostridium difficile Hospital Ward–Based Transmission Using Extensive Epidemiological Data and Molecular Typing. PLoS Med 9(2): e1001172. doi:10.1371/journal.pmed.1001172

Related Stories

C. difficile lengthens hospital stays by 6 days

December 5, 2011

A new study published in the CMAJ (Canadian Medical Association Journal) reports that hospital-acquired Clostridium difficile infection increases length of stay in hospital by an average of six days.

Recommended for you

Experimental MERS vaccine shows promise in animal studies

July 28, 2015

A two-step regimen of experimental vaccines against Middle East respiratory syndrome (MERS) prompted immune responses in mice and rhesus macaques, report National Institutes of Health scientists who designed the vaccines. ...

Can social isolation fuel epidemics?

July 21, 2015

Conventional wisdom has it that the more people stay within their own social groups and avoid others, the less likely it is small disease outbreaks turn into full-blown epidemics. But the conventional wisdom is wrong, according ...

Lack of knowledge on animal disease leaves humans at risk

July 20, 2015

Researchers from the University of Sydney have painted the most detailed picture to date of major infectious diseases shared between wildlife and livestock, and found a huge gap in knowledge about diseases which could spread ...

IBD genetically similar in Europeans and non-Europeans

July 20, 2015

The first genetic study of inflammatory bowel disease (IBD) to include individuals from diverse populations has shown that the regions of the genome underlying the disease are consistent around the world. This study, conducted ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.