Association of Household Exposure to Primary Clostridioides difficile Infection With Secondary Infection in Family Members

Abstract

IMPORTANCE Clostridioides difficile infection (CDI) is a common hospital-acquired infection.Whether family members are more likely to experience a CDI following CDI in another separate family member remains to be studied. OBJECTIVETo determine the incidence of potential family transmission of CDI. DESIGN, SETTING, AND PARTICIPANTSIn this case-control study comparing the incidence of CDI among individuals with prior exposure to a family member with CDI to those without prior family exposure, individuals were binned into monthly enrollment strata based on exposure status (eg, family exposure) and confounding factors (eg, age, prior antibiotic use). Data were derived from population-based, longitudinal commercial insurance claims from the Truven Marketscan Commercial Claims and Encounters and Medicare Supplemental databases from 2001 to 2017.Households with at least 2 family members continuously enrolled for at least 1 month were eligible.CDI incidence was computed within each stratum. A regression model was used to compare incidence of CDI while controlling for possible confounding characteristics.EXPOSURES Index CDI cases were identified using inpatient and outpatient diagnosis codes.Exposure risks 60 days prior to infection included CDI diagnosed in another family member, prior hospitalization, and antibiotic use. MAIN OUTCOMES AND MEASURESThe primary outcome was the incidence of CDI in a given monthly enrollment stratum. Separate analyses were considered for CDI diagnosed in outpatient or hospital settings. RESULTS A total of 224 818 cases of CDI, representing 194 424 enrollees (55.9% female; mean [SD] age, 52.8 [22.2] years) occurred in families with at least 2 enrollees. Of these, 1074 CDI events (4.8%) occurred following CDI diagnosis in a separate family member. Prior family exposure was significantly associated with increased incidence of CDI, with an incidence rate ratio (IRR) of 12.47 (95% CI, 8.86-16.97); this prior family exposure represented the factor with the second highest IRR behind hospital exposure (IRR, 16.18 [95% CI,). For community-onset CDI cases without prior hospitalization, the IRR for family exposure was 21.74 (95% CI, 15.12-30.01). Age (IRR, 9.90 [95% CI, for ages Ն65 years compared with ages 0-17 years), antibiotic use (IRR, 3.73 [95% CI, for for high-risk antibiotics compared with no antibiotics), and female sex (IRR, 1.44 [95% CI,) were also positively associated with incidence. CONCLUSIONS AND RELEVANCEThis study found that individuals with family exposure may be at significantly greater risk for acquiring CDI, which highlights the importance of the shared (continued) Key Points Question Is exposure to a family member with Clostridioides difficile infection associated with a greater risk for acquiring C difficile infection in exposed individuals? Findings In this case-control study of 224 818 cases of C difficile infection representing 194 424 insurance plan enrollees, having a family member with C difficile infection was significantly associated with increased incidence of C diffic...

Risks and Preventive Strategies for Clostridioides difficile Transmission to Household or Community Contacts during Transition in Healthcare Settings

“…Of patients with community-acquired CDI and no outpatient healthcare exposure, the odds ratio of having a household member with active CDI was 6.8 (95% CI 0.7-65.9) compared with patients who had high-level outpatient healthcare exposure (6). However, the study did not verify the (9). In addition, Loo et al evaluated probable transmission rates of 1.5% and possible transmission rates of 7.5% for household contacts of 51 CDI patients (10).…”

“…Similar to the study of Chitnis et al ( 6 ), this study did not define what isolation or prophylactic measures were taken to reduce transmission to household contacts. However, a more recent study by Miller et al conducted among 194,424 enrollees, published after our original search was completed, indicated a 12.47 incidence rate ratio among household contacts of DCI patients discharged from tertiary care centers ( 9 ). In addition, Loo et al evaluated probable transmission rates of 1.5% and possible transmission rates of 7.5% for household contacts of 51 CDI patients ( 10 ).…”

“…Available data demonstrate the considerable extent of C. difficile in the community ( 12 ), evidence of C. difficile on household surfaces among patients who have recurrent CDI ( 18 ), a rate of probable transmission of 1.5% and a rate of possible transmission of 7.5% for household contacts of discharged CDI patients ( 10 ). More recently, the incidence rate ratio of CDI was reported as 12.47 for household contacts of discharged patients who have CDI ( 9 ). However, no systematic data provide evidence of effective prevention strategies at the community level and with household contacts of index patients discharged from the hospital.…”

Epidemiology of community-acquired and recurrent Clostridioides difficile infection

“…27 A recent analysis of more than 224,000 CDI cases from a large national insurance enrollee database found exposure through family members as the greatest factor for the increased incidence of CA-CDI. 41 A meta-analysis from North America on the relationship of toxigenic C. difficile colonization and subsequent infection found 14.8% of long-term care residents were asymptomatic carriers of toxigenic strains. 42 Another meta-analysis explored the colonization rates of patients upon admission to hospitals and found the global rate to be 8.1%.…”

Spelling Error in Author Name

“…In the Original Investigation titled “Association of Household Exposure to Primary Clostridioides difficile Infection With Secondary Infection in Family Members,” 1 published on June 26, 2020, there was a spelling error in the author byline. The name given as “Sriram V. Pemmeraju, PhD,” should have been “Sriram V. Pemmaraju, PhD.” This article has been corrected.…”