Are Many Patients Diagnosed With Healthcare-associated Clostridioides difficile Infections Colonized With the Infecting Strain on Admission?

Gonzalez-Orta, Melany; Saldana, Carlos; Ng-Wong, Yilen K; Cadnum, Jennifer L.; Jencson, Annette; Jinadatha, Chetan; Donskey, Curtis J.

doi:10.1093/cid/ciz189

Cited by 13 publications

(6 citation statements)

References 12 publications

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“…This suggests that community sources could also be playing a role in HA‐CDI cases. Although the exact mode of transmission is unknown, it is likely to be via asymptomatic carriers who acquire C. difficile in the community before transporting it into a hospital setting or via symptomatic cases after hospital admission, as shown in recent studies (Gonzalez‐Orta et al ., 2019; Halstead et al ., 2019; Sheth et al ., 2019).…”

Section: Resultsmentioning

confidence: 99%

Clostridium difficile in soil conditioners, mulches and garden mixes with evidence of a clonal relationship with historical food and clinical isolates

Lim

Knight

Moono

et al. 2020

Environ Microbiol Rep

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With rates of community-associated Clostridium difficile infection (CA-CDI) increasing worldwide, potential reservoirs/sources of C. difficile in the community are being sought. Since C. difficile is found in animal manure and human biosolids, which are composted for agricultural purposes, composted products could be a source. In this study, the presence of C. difficile in composted products, and their genetic relatedness to other previously isolated strains from humans, root vegetables and the environment in Western Australia, was investigated. Overall, C. difficile was found in 22.5% (16/71) of composted products [29.7% (11/37) of soil conditioners, 16.7% (2/12) of mulches and 13.6% (3/22) of garden mixes]. Fifteen C. difficile PCR ribotypes (RTs) were identified, the most common toxigenic strains being RTs 020 and 056. Clostridium difficile RT 056 is commonly associated with CDI in humans and has also been isolated from cattle, root vegetables and the environment (veterinary clinics and lawn) in Australia. High-resolution coregenome analysis of 29 C. difficile RT 056 strains revealed clonal relationships between isolates derived from humans, vegetables, composted products and the environment. These findings provide support for an intricate transmission network between human, food and the environment, further highlighting the importance of a 'One Health' approach for managing CDI.

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Section: Resultsmentioning

confidence: 99%

Clostridium difficile in soil conditioners, mulches and garden mixes with evidence of a clonal relationship with historical food and clinical isolates

Lim

Knight

Moono

et al. 2020

Environ Microbiol Rep

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“…In 2013, Eyre et al [ 7 ] found that 45% of isolates from CDI cases were genetically distinct from those from previous CDI cases (cgSNPs > 10), and only 35% of isolates were related (cgSNP ≤ 2), suggesting that diverse sources, in addition to symptomatic patients, play a major role in C. difficile transmission. In addition, a study conducted by Gonzalez-Orta et al [ 38 ] showed that more than a quarter of patients diagnosed with HA-CDI at Cleveland Hospital in the United States were infected with strains that colonized on admission. Subsequently, studies found that asymptomatic hospitalized carriers are a potential source for transmission of CDI strains among long-term care facility residents [ 6 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

Comparative genomic and transmission analysis of Clostridioides difficile between environmental, animal, and clinical sources in China

Zhou

Xiao

et al. 2021

Emerging Microbes & Infections

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Clostridioides difficile is the most common pathogen causing antibiotic-associated diarrhea. Previous studies showed that diverse sources, aside from C. difficile infection (CDI) patients, played a major role in C. difficile hospital transmission. This study aimed to investigate relationships and transmission potential of C. difficile strains from different sources. A prospective study was conducted both in the intensive care unit (ICU) and six livestock farms in China in 2018–2019. Ninety-eight strains from CDI patients (10 isolates), asymptomatic hospitalized carriers (55), the ICU environment (12), animals (14), soil (4), and farmers (3) were collected. Sequence type (ST) 3/ribotype (RT) 001, ST35/RT046, and ST48/RT596 were dominant types, distributed widely in multiple sources. Core-genome single-nucleotide polymorphism (cgSNP) analysis showed that hospital and farm strains shared several common clonal groups (CGs, strains separated by ≤ 2 cgSNPs) (CG4/ST3/RT001, CG7/ST35/RT046, CG11/ST48/RT596). CDI patients, asymptomatic carriers, and the ICU environment strains also shared several common CGs. The number of virulence genes was not statistically different between strains from different sources. Multi-source strains in the same CG carried identical virulence gene sequences, including pathogenicity genes at the pathogenicity locus and adhesion-related genes at S-layer cassette. Resistance genes ( ermB , tetM , etc.) were widespread in multiple sources, and multi-source strains in the same CG had similar resistance phenotypes and carried consistent transposons and plasmid types. The study indicated that interspecies and cross-regional transmission of C. difficile occurs between animals, the environment, and humans. Community-associated strains from both farms and asymptomatic hospitalized carriers were important reservoirs of CDI in hospitals.

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“…However, we also hypothesize that patients with detectable levels of C. difficile are more likely to transmit than patients with undetected levels of C. difficile . Fourth, we did not have isolates from clinically diagnosed CDI, so we could not verify whether colonizing strains were genomically matched to those from later infections, although the limited existing data from previous reports suggest high concordance between colonizing and subsequent infecting strain types 43 . Lastly, the hospital laboratory’s use of a tcdB -targeting PCR test alone for suspected CDI during the study could have resulted in overdiagnosis of CDI in patients who were colonized with toxigenic C. difficile and who had diarrhea from other causes.…”

Section: Discussionmentioning

confidence: 97%

Longitudinal genomic surveillance of carriage and transmission of Clostridioides difficile in an intensive care unit

Miles-Jay,

Snitkin,

Lin

et al. 2023

Nat Med

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Despite enhanced infection prevention efforts, Clostridioides difficile remains the leading cause of healthcare-associated infections in the United States. Current prevention strategies are limited by their failure to account for patients who carry C. difficile asymptomatically, who may act as hidden reservoirs transmitting infections to other patients. To improve the understanding of asymptomatic carriers’ contribution to C. difficile spread, we conducted admission and daily longitudinal culture-based screening for C. difficile in a US-based intensive care unit over nine months and performed whole-genome sequencing on all recovered isolates. Despite a high burden of carriage, with 9.3% of admissions having toxigenic C. difficile detected in at least one sample, only 1% of patients culturing negative on admission to the unit acquired C. difficile via cross-transmission. While patients who carried toxigenic C. difficile on admission posed minimal risk to others, they themselves had a 24-times greater risk for developing a healthcare-onset C. difficile infection than noncarriers. Together, these findings suggest that current infection prevention practices can be effective in preventing nosocomial cross-transmission of C. difficile, and that decreasing C. difficile infections in hospitals further will require interventions targeting the transition from asymptomatic carriage to infection.

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Are Many Patients Diagnosed With Healthcare-associated Clostridioides difficile Infections Colonized With the Infecting Strain on Admission?

Cited by 13 publications

References 12 publications

Clostridium difficile in soil conditioners, mulches and garden mixes with evidence of a clonal relationship with historical food and clinical isolates

Clostridium difficile in soil conditioners, mulches and garden mixes with evidence of a clonal relationship with historical food and clinical isolates

Comparative genomic and transmission analysis of Clostridioides difficile between environmental, animal, and clinical sources in China

Longitudinal genomic surveillance of carriage and transmission of Clostridioides difficile in an intensive care unit

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