Screening for Asymptomatic Clostridioides difficile Carriage Among Hospitalized Patients: A Narrative Review

Abstract

Clostridioides difficile infection (CDI) has become the most common healthcare-associated infection in the United States, with considerable morbidity, mortality, and healthcare costs. Assessing new preventive strategies is vital. We present a literature review of studies evaluating a strategy of screening and isolation of asymptomatic carriers in hospital settings. Asymptomatic detection of C. difficile is reported in ~ 10–20% of admitted patients. Risk factors for carriage include recent hospitalization, previous antibiotics, older age, lower functional capacity, immunosuppression, and others. Asymptomatic C. difficile carriers of toxigenic strains are at higher risk for progression to CDI. They are also shedders of C. difficile spores and may contribute to the persistence and transmission of this bacterium. Screening for asymptomatic carriers at hospital admission can theoretically reduce CDI by isolating carriers to reduce transmission, and implementing antibiotic stewardship measures targeting carriers to prevent progression to clinical illness. Several observational studies, summarized in this review, have reported implementing screening and isolation strategies, and found a reduction in CDI rates. Nevertheless, the data are still limited to a few observational studies, and this strategy is not commonly practiced. Studies supporting screening were performed in North America, coinciding with the period of dominance of the 027/BI/NAP1 strain. Additional studies evaluating screening, followed by infection control and antibiotic stewardship measures, are needed.

Clostridioides difficile Infection in Kidney Transplant Recipients

“…The early timing of CDI development following kidney transplantation is likely attributed to the potential asymptomatic colonization with C. difficile before and during the transplant procedure. It has been highlighted that asymptomatic detection of C. difficile is prevalent in between 10 and 20% of individuals admitted to the hospital [ 26 ]. Community-acquired CDI as a route of transmission in the post-transplant population should be acknowledged [ 27 ].…”

Clostridioides difficile Toxins: Host Cell Interactions and Their Role in Disease Pathogenesis

“…Asymptomatic carriage of toxigenic strains upon hospital admission is common, estimated at around 10 to 20% according to recent meta-analyses, significantly elevating the risk of developing CDI compared to non-colonized patients [ 14 ]. Although CDI typically occurs in hospitalized elderly patients who have been administered antibiotics, there has been a rise in the occurrence of CDI in the community among young adults who have not been exposed to antibiotics.…”