NEW YORK (December 11, 2019) -- Nearly 1-in-10 patients admitted to a New York hospital with no symptoms of diarrhea were found to be carriers of Clostridioides difficile (C. diff), suggesting infections originate outside the hospital setting more often than thought, according to a study published today in Infection Control & Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America.
The results suggest that hospitals and other healthcare facilities could consider identifying carriers of C. diff as a strategy to prevent the spread of the infection. According to a 2015 report, more than 400,000 cases of C. diff, resulting in nearly 30,000 deaths, are reported each year in the United States.
"It has generally been assumed that patients get the bacteria during their stay in the hospital," said Sarah Baron, MD, MS, the lead author of the study and the Director of Inpatient Quality Improvement in the Department of Medicine in Montefiore Health System and Assistant Professor of Medicine at Albert Einstein College of Medicine. "However, when we tested patients being admitted to the hospital, we found that many of them were carrying the bacteria that causes this diarrhea in their bodies already and often went on to develop the infection."
Researchers at Montefiore tested 220 patients who showed no symptoms of C. diff infection when they were admitted between July 2017 and March 2018. Perirectal swabs were completed within 24 hours of admission, and the patients were followed for six months. Upon admission, 21 patients were identified as carriers.
Within six months, 38 percent of the carriers progressed to symptomatic C. diff infection compared to just 2 percent of the non-carriers.
The study also suggests that there is a large pool of people who carry the organism that go unrecognized and may pass it on to others and/or develop an infection themselves, Baron said.
"These findings might mean that we can predict who will develop C. diff and try to stop it before it starts," Baron said. "More work is needed to determine how we can protect everyone, even the patients who already have the bacteria in their colons, from developing this dangerous form of diarrhea."
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Sarah Baron, Belinda Ostrowsky, Priya Nori, David Drory, Michael Levi, Wendy Szymczak, Michael Rinke, William Southern. "Screening of Clostridioides difficile carriers in an urban academic medical center: Understanding implications of disease." Infection Control & Hospital Epidemiology. Web (December 11, 2019)
About ICHE
Published through a partnership between the Society for Healthcare Epidemiology of America and Cambridge University Press, Infection Control & Hospital Epidemiology provides original, peer reviewed scientific articles for anyone involved with an infection control or epidemiology program in a hospital or healthcare facility. ICHE is ranked 41st out of 89 Infectious Diseases Journals in the latest Web of Knowledge Journal Citation Reports from Thomson Reuters.
The Society for Healthcare Epidemiology of America (SHEA) is a professional society representing more than 2,000 physicians and other healthcare professionals around the world who possess expertise and passion for healthcare epidemiology, infection prevention, and antimicrobial stewardship. The society's work improves public health by establishing infection-prevention measures and supporting antibiotic stewardship among healthcare providers, hospitals, and health systems. This is accomplished by leading research studies, translating research into clinical practice, developing evidence-based policies, optimizing antibiotic stewardship, and advancing the field of healthcare epidemiology. SHEA and its members strive to improve patient outcomes and create a safer, healthier future for all. Visit SHEA online at http://www.shea-online.org, http://www.facebook.com/SHEApreventingHAIs and @SHEA_Epi.
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Journal
Infection Control and Hospital Epidemiology