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Impact of Toxigenic Clostridium difficile Colonization on the Risk of Subsequent C. difficile Infection in Intensive Care Unit Patients

Published online by Cambridge University Press:  30 July 2015

Sarah Tschudin-Sutter ,
Karen C. Carroll ,
Pranita D. Tamma ,
Madeleine L. Sudekum ,
Reno Frei ,
Andreas F. Widmer ,
Brandon C. Ellis ,
John Bartlett  and
Trish M. Perl
Sarah Tschudin-Sutter*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
Karen C. Carroll
Affiliation:
Division of Medical Microbiology, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland
Pranita D. Tamma
Affiliation:
Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
Madeleine L. Sudekum
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Reno Frei
Affiliation:
Division of Clinical Microbiology, University Hospital Basel, Basel, Switzerland
Andreas F. Widmer
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
Brandon C. Ellis
Affiliation:
Division of Medical Microbiology, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland
John Bartlett
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Trish M. Perl
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
*
Address correspondence to Sarah Tschudin-Sutter, MD, MSc, Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland (sarah.tschudin@usb.ch).
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Abstract

BACKGROUND

Clostridium difficile infection (CDI) in hospitalized patients is generally attributed to the current stay, but recent studies reveal high C. difficile colonization rates on admission.

OBJECTIVE

To determine the rate of colonization with toxigenic C. difficile among intensive care unit patients upon admission as well as acquired during hospitalization, and the risk of subsequent CDI.

METHODS

Prospective cohort study from April 15 through July 8, 2013. Adults admitted to an intensive care unit within 48 hours of admission to the Johns Hopkins Hospital, Baltimore, Maryland, were screened for colonization with toxigenic C. difficile. The primary outcome was risk of developing CDI.

RESULTS

Among 542 patients, 17 (3.1%) were colonized with toxigenic C. difficile on admission and an additional 3 patients were found to be colonized during hospitalization. Both colonization with toxigenic C. difficile on admission and colonization during hospitalization were associated with an increased risk for development of CDI (relative risk, 10.29 [95% CI, 2.24–47.40], P=.003; and 15.66 [4.01–61.08], P<.001, respectively). Using multivariable analysis, colonization on admission and colonization during hospitalization were independent predictors of CDI (relative risk, 8.62 [95% CI, 1.48–50.25], P=.017; and 10.93 [1.49–80.20], P=.019, respectively), while adjusting for potential confounders.

CONCLUSIONS

In intensive care unit patients, colonization with toxigenic C. difficile is an independent risk factor for development of subsequent CDI. Further studies are needed to identify populations with higher toxigenic C. difficile colonization rates possibly benefiting from screening or avoidance of agents known to promote CDI.

Infect. Control Hosp. Epidemiol. 2015;36(11):1324–1329

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 11 , November 2015 , pp. 1324 - 1329
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

Presented in part: 24th European Congress of Clinical Microbiology and Infectious Diseases; Barcelona, Spain; May 11, 2014 (Abstract P0773).

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