Natural History of Clostridioides difficile Colonization and Infection Following New Acquisition of Carriage in Healthcare Settings: A Prospective Cohort Study

Abstract

Background Limited information is available on the natural history of Clostridioides difficile colonization and infection in patients with new acquisition of C. difficile in healthcare settings. Methods In 3 hospitals and affiliated long-term care facilities, we collected serial perirectal cultures from patients with no diarrhea on enrollment to identify new acquisition of toxigenic C. difficile carriage and determined the duration and burden of carriage. Asymptomatic carriage was defined as transient if only 1 culture was positive with negative cultures before and after or persistent if 2 or more cultures were positive. Clearance of carriage was defined as 2 consecutive negative perirectal cultures. Results Of 1,432 patients with negative initial cultures and at least 1 follow-up culture, 39 (2.7%) developed CDI without prior detection of carriage and 142 (9.9%) acquired asymptomatic carriage with 19 (13.4%) subsequently diagnosed with CDI. Of 82 patients analyzed for persistence of carriage, 50 (61.0%) had transient carriage and 32 (39.0%) had persistent carriage, with an estimated median of 77 days to clearance of colonization (range, 14 to 133 days). Most persistent carriers had a relatively high burden of carriage and maintained the same ribotype over time, whereas most transient carriers had a low burden of carriage detected only using broth enrichment cultures. Conclusions In 3 healthcare facilities, 9.9% of patients acquired asymptomatic carriage of toxigenic C. difficile, and 13.4% were subsequently diagnosed with CDI. Most carriers had transient rather than persistent carriage and most patients developing CDI did not have prior detection of carriage.

Animal and In Vitro Models as Powerful Tools to Decipher the Effects of Enteric Pathogens on the Human Gut Microbiota

“…It naturally colonizes the human intestinal tract after the ingestion of spores and inhabits the gut as a peaceful commensal. Percentages of C. difficile asymptomatic colonization range from 0% to 51% in the population, mainly depending on age, geography, access to healthcare structures and hospitalization, and other environmental factors [ 59 , 60 , 61 , 62 ]. However, some toxigenic strains are sadly known for their ability to cause antibiotic-associated diarrhea in hospitalized patients (healthcare-associated infections), taking advantage of the intestinal dysbiosis resulting from prolonged use of broad-spectrum antibiotics [ 63 , 64 ].…”

A novel approach to correcting attribution of Clostridioides difficile in a healthcare setting

“…Among our limitations was the 15-day duration of attribution used to estimate the most likely period of acquisition (transmission) and/or antibiotic exposure that precipitated C. difficile clinical disease resulting in testing. This estimate is a reasonable approximation given previous reports of incubation period and preceding antibiotic use 10,13,14,[24][25][26] but will not be a precise estimate for every patient. The study involves only two medical centers with relatively small numbers.…”

Breaking Boundaries in Pneumonia Diagnostics: Transitioning from Tradition to Molecular Frontiers with Multiplex PCR

“…This led to the development of nucleic acid amplification tests (NAATs) which established highly sensitive testing. However, these highly sensitive tests are prone to detecting colonization as well, which occurs in 7-18% of hospitalized patients [48] and contributes to subsequent overdiagnosis [49]. Two landmark studies by Polage et al and Planche et al were conducted to address the issue of overdiagnosis by NAAT, which evaluated the natural history of this disease and the need for treatment in the setting of various toxin EIA and NAAT results [49,50].…”