Prevalence of Clostridium difficile colonization among healthcare workers

Abstract

BackgroundClostridium difficile infection (CDI) has increased to epidemic proportions in recent years. The carriage of C. difficile among healthy adults and hospital inpatients has been established. We sought to determine whether C. difficile colonization exists among healthcare workers (HCWs) in our setting.MethodsA point prevalence study of stool colonization with C. difficile among doctors, nurses and allied health staff at a large regional teaching hospital in Geelong, Victoria. All participants completed a short questionnaire and all stool specimens were tested by Techlab® C.diff Quik Check enzyme immunoassay followed by enrichment culture.ResultsAmong 128 healthcare workers, 77% were female, of mean age 43 years, and the majority were nursing staff (73%). Nineteen HCWs (15%) reported diarrhoea, and 12 (9%) had taken antibiotics in the previous six weeks. Over 40% of participants reported having contact with a patient with known or suspected CDI in the 6 weeks before the stool was collected. C. difficile was not isolated from the stool of any participants.ConclusionAlthough HCWs are at risk of asymptomatic carriage and could act as a reservoir for transmission in the hospital environment, with the use of a screening test and culture we were unable to identify C. difficile in the stool of our participants in a non-outbreak setting. This may reflect potential colonization resistance of the gut microbiota, or the success of infection prevention strategies at our institution.

Risk of serious infection in healthcare workers with inflammatory bowel disease: a case‐control study of the Groupe d'Etude Thérapeutique des Affections Inflammatoires du tube Digestif (GETAID)

“…In IBD, colonic dysbiosis and exposure to immunosuppressive therapy may allow Clostridium difficile infection to develop in the absence of any antibiotic therapy. Whether healthcare workers exhibit increased carriage of Clostridium difficile and are at increased risk for developing Clostridium difficile infection remain unclear . In the present study, healthcare workers did not present an increased risk of Clostridium difficile infection.…”

Spectrum of enteropathogens detected by the FilmArray GI Panel in a multicentre study of community-acquired gastroenteritis

“…Considering the importance of toxigenic C. difficile, we conclude that laboratories should evaluate the need for routine toxigenic C. difficile testing of samples from patients with community-acquired diarrhoea. In this context, we note that, in contrast to EPEC, toxigenic C. difficile is infrequently found in healthy adults [21,22]. Current guidelines for the diagnosis of CDI state that algorithm testing should be used, as stand-alone tests are not suitable with regard to sensitivity/specificity, especially when tests are performed in low-prevalence populations [23].…”

Changes in intestinal microbiota and their effects on allogeneic stem cell transplantation

“…Asymptomatic patients with hematologic malignancies prior to allogeneic HSCT have been shown to have a C difficile colonization rate ranging from 8% to 29%, with approximately 12% colonized with a toxigenic strain . In contrast, C difficile colonization rate is much lower in the general population and only approximately 8% colonized with the toxigenic strain …”