Targeted C. difficile screening at hospital admission could potentially ID most colonized patients

April 30, 2013

Testing patients with just three risk factors upon hospital admission has potential to identify nearly three out of four asymptomatic carriers of C. difficile, according to a new study published in the May issue of the American Journal of Infection Control, the official publication of the Association for Professionals in Infection Control and Epidemiology (APIC).

Researchers from Mayo Clinic in Rochester, MN, analyzed from 320 showing no symptoms of C. difficile at using a real-time (PCR) assay. Samples from 31 of 320 patients tested positive for C. difficile, resulting in a colonization rate of 9.7 percent. The authors wanted to estimate the reservoir of colonized patients as a source of potential transmission because despite rigorous infection control measures, C. difficile infection was increasing at their institution.

In this study, independent predictors of C. difficile colonization were found to be recent hospitalization, and corticosteroid use. According to the authors, one or more of the three independent risk factors were present in 155 (48 percent) of study participants, and screening only those with one or more of these factors would have identified 23 C. difficile carriers (74 percent).

"In our population, by targeting those with identified risk factors, we would need to screen approximately half of those patients with anticipated stays longer than 24 hours, to identify three-fourths of those colonized with C. difficile," said the authors. "This is in the range of previously published screening efficiency rates for ."

However, the authors also state that these results should be interpreted keeping in mind that only 22 percent of all eligible patients provided stool for C. difficile PCR, and the study population was not representative of all patients admitted to the hospital.

"Our objective was to estimate the burden of asymptomatic C. difficile carriers at admission because that constitutes an important checkpoint where can be assessed and infection prevention measures instituted," said the authors. "This is the first study to demonstrate the feasibility of performing C. difficile surveillance on hospitalized patients at admission. The role of asymptomatic carriers in transmitting C. difficile should be studied further, and the utility of PCR-based targeted surveillance to detect asymptomatic carriers should be explored in areas of high endemicity or outbreak settings when other control measures have been exhausted."

"While more research needs to be conducted on the transmission of C. difficile infection from colonized patients, this study may help institutions with persistently high rates of transmission develop an expanded strategy for targeted C. difficile surveillance," said APIC 2013 President Patti Grant, RN, BSN, MS, CIC. "The study does not indicate necessity for all healthcare facility implementation, yet provides a step-wise progressive approach to help impede C. difficile activity when considering the overall epidemiologic impact of transmission."

C. difficile causes infectious diarrhea and is linked to 14,000 American deaths each year, according to the Centers for Disease Control and Prevention. While many types of healthcare-associated infections have declined in recent years, infections from C. difficile have increased. APIC recently issued a new open-access Guide to Preventing C. difficile infections.

Explore further: C. difficile lengthens hospital stays by 6 days

More information: "Asymptomatic Clostridium difficile colonization in a tertiary care hospital: Admission prevalence and risk factors," by Surbhi Leekha, Kimberly C. Aronhalt, Lynne M. Sloan, Robin Patel and Robert Orenstein appears in the American Journal of Infection Control, Volume 41, Issue 5 (May 2013).

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.

Dogs can accurately sniff out 'superbug' infections

December 13, 2012

Dogs can sniff out Clostridium difficile (the infective agent that is responsible for many of the dreaded "hospital acquired infections") in stool samples and even in the air surrounding patients in hospital with a very high ...

Recommended for you

Monkeys in Asia harbor virus from humans, other species

November 19, 2015

When it comes to spreading viruses, bats are thought to be among the worst. Now a new study of nearly 900 nonhuman primates in Bangladesh and Cambodia shows that macaques harbor more diverse astroviruses, which can cause ...

One-step test for hepatitis C virus infection developed

November 14, 2015

UC Irvine Health researchers have developed a cost-effective one-step test that screens, detects and confirms hepatitis C virus (HCV) infections. Dr. Ke-Qin Hu, director of hepatology services, will present findings at the ...


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.