Asymptomatic Clostridium difficile colonization: epidemiology and clinical implications

Abstract

BackgroundThe epidemiology of Clostridium difficile infection (CDI) has changed over the past decades with the emergence of highly virulent strains. The role of asymptomatic C. difficile colonization as part of the clinical spectrum of CDI is complex because many risk factors are common to both disease and asymptomatic states. In this article, we review the role of asymptomatic C. difficile colonization in the progression to symptomatic CDI, describe the epidemiology of asymptomatic C. difficile colonization, assess the effectiveness of screening and intensive infection control practices for patients at risk of asymptomatic C. difficile colonization, and discuss the implications for clinical practice.MethodsA narrative review was performed in PubMed for articles published from January 1980 to February 2015 using search terms ‘Clostridium difficile’ and ‘colonization’ or ‘colonisation’ or ‘carriage’.ResultsThere is no clear definition for asymptomatic CDI and the terms carriage and colonization are often used interchangeably. The prevalence of asymptomatic C. difficile colonization varies depending on a number of host, pathogen, and environmental factors; current estimates of asymptomatic colonization may be underestimated as stool culture is not practical in a clinical setting.ConclusionsAsymptomatic C. difficile colonization presents challenging concepts in the overall picture of this disease and its management. Individuals who are colonized by the organism may acquire protection from progression to disease, however they also have the potential to contribute to transmission in healthcare settings.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-1258-4) contains supplementary material, which is available to authorized users.

Clostridium difficile Infection Diagnosis by Biological Molecular Methods

“…All methods try to rapidly identify the infected strain, but there are no solid arguments in differentiating between infection and colonization (positive C. difficile diagnosis, in the lack of symptoms). An excellent synthesis regarding colonization (carriage) and its role as a source of infection was published recently by Furuya-Kanamory et al; the need of colonized patient identification is obvious: their prevalence is higher than in symptomatic cases; they can become a dangerous source of infection, and preventive methods must target them [98]. The cited study also made a vast synthesis of prevalence colonization rate over the world, which varied in large limits: 0-15% for healthy adults, almost 30% in colonized patients with nontoxigenic strains, and 0-51% in elderly residents of healthcare institutions [98].…”

Fecal microbiota transplantation, a novel therapy for recurrent Clostridium difficile infection

“…CDI is geassocieerd met ziekenhuisopnamen en verpleeghuizen. Afh ankelijk van de populatie waarin men kijkt, is ongeveer 5% (0-15%) van de mensen drager van de Clostridium diffi cile-bacterie (Furuya-Kanamori et al, 2015). Bij patiënten in een ziekenhuis of mensen in een verpleeghuis is deze incidentie veel hoger, variërend van 5 tot 40%.…”

Fifteen-minute consultation on the healthy child: Bowel habit in infants and children

“…If there is a history of preceding infection or blood in stools, a sample for microscopy, culture and sensitivity helps reassure parents regarding the absence of bacterial infection. When testing for Clostridium difficile , consider the high likelihood of C. difficile toxin excretion (up to 90%) in healthy children under the age of 2 years 9. Investigations for malabsorption include stool reducing substances and chromatography.…”