Wednesday, May 15, 2013

Asymptomatic Clostridium difficile Carriage- Uncharted Waters

Here is a recent publication on C.difficile carriage authored by my colleague and SHEA Guidelines Committee collaborator, Dr. Surbhi Leekha.

The investigators assessed the first stool sample after admission from consenting patients and tested it for toxigenic C.difficile  using polymerase chain reaction. .

Of 320 participants, 31 (9.7%) were positive for toxigenic CD. Using multivariate logistic regression, independent predictors of C.difficile  colonization were recent hospitalization (odds ratio [OR], 2.45; 95% confidence interval [CI]: 1.02-5.84), chronic dialysis (OR, 8.12; 95% CI: 1.80-36.65), and corticosteroid use (OR, 3.09; 95% CI: 1.24-7.73). Screening patients with risk factors (48% participants) would identify 74% (95% CI: 55%-88%) of C.difficile  carriers.

These findings are important. So what happens next?

The implications are unclear. I hope that we do not get carried away as we did with active detection and isolation of MRSA, a strategy which is falling out of favor in some healthcare settings.  In other words, I hope that we do not begin widespread active detection and isolation for C.difficile carriage anytime soon. Rather, infection prevention measures such as hand hygiene (with soap and water, to physically remove spores from the hands), robust terminal disinfection of patient rooms with sporicidal agents and judicious antibiotic use with oversight from an antibiotic stewardship program should be vigorously promoted across all populations to control endemic C.difficile infection. This is all part of a horizontal infection control strategy.

The asymptomatic carriage of C.difficile needs to be studied further.

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