Environmental shedding of toxigenic Clostridioides difficile by asymptomatic carriers: A prospective observational study. (August 2020)

• Record Type: Journal Article
• Authors: Amital, Howard; Beni, Sharon; Ben-Zvi, Ilan; Blausov, Natasha; Brom, Adi; Cohen, Carmit; Feld-Simon, Olga; Fluss, Ronen; Gilboa, Mayan; Eden-Friedman, Yehudit; Halevy, Shiraz; Houri-Levi, Esther; Hupert, Amit; Jbarien, Amnah; Keller, Naty; Leibowitz, Avshalom; Mayan, Haim; Maizels, Leonid; Meltzer, Eyal; Pinas-Zade, Nani; Rahav, Galia; Raibman-Spector, Shir; Regev-Yochay (PI), Gili; Romiantsev, Marina; Shachar, Dalit; Sharif, Kassem; Segal, Gadi; Segal, Shoshi; Segev, Amitai; Smollan, Gill; Stienlauf, Shmuel; Tal, Ilana; Yonath, Hagit; Zilberman-Daniels, Tal; Zimlichman, Eyal; Gilboa, M.; Houri-Levi, E.; Cohen, C.; Tal, I.; Rubin, C.; Feld-Simon, O.; Brom, A.; Eden-Friedman, Y.; Segal, S.; Rahav, G.; Regev-Yochay, G.;
• Is Part Of: Clinical microbiology and infection. Volume 26:Number 8(2020)
• Page Start: 1052
• Page End: 1057
• Publication Date: 2020-08
• Subjects: Asymptomatic carriers -- Clostridioides difficile -- Environmental contamination -- Infection control -- Isolation; Medical microbiology -- Periodicals; Diagnostic microbiology -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 616.01
• DOI: 10.1016/j.cmi.2019.12.011
• Languages: English
• ISSNs: 1198-743X

Abstract

Abstract: Objectives: The aim was to compare the burden of environmental shedding of toxigenic Clostridioides difficile among asymptomatic carriers, C. difficile -infected (CDI) patients and non-carriers in an inpatient non-epidemic setting. Methods: C. difficile carriage was determined by positive toxin-B PCR from rectal swabs of asymptomatic patients. Active CDI was defined as a positive two-step enzyme immunoassay/polymerase chain reaction (EIA/PCR) test in patients with more than three unformed stools/24 hr. C. difficile environmental contamination was assessed by obtaining specimens from ten sites in the patients' rooms. Toxigenic strains were identified by PCR. We created a contamination scale to define the overall level of room contamination that ranged from clean to heavy contamination. Results: One hundred and seventeen rooms were screened: 70 rooms inhabited by C . difficile carriers, 30 rooms by active CDI patients and 17 rooms by non C . difficile -carriers (control). In the carrier rooms 29 (41%) had more than residual contamination, from which 17 (24%) were heavily contaminated. In the CDI rooms 12 (40%) had more than residual contamination from which three (10%) were heavily contaminated, while in the control rooms, one room (6%) had more than residual contamination and none were heavily contaminated. In a multivariate analysis, the contamination score of rooms inhabited by carriers did not differ from rooms of CDI patients, yet both were significantly more contaminated than those of non-carriers odd ratio 12.23 and 11.16 (95% confidence interval 1.5–99.96 p 0.0195, and 1.19–104.49 p 0.035), respectively. Discussion: Here we show that the rooms of C. difficile carriers are as contaminated as those of patients with active CDI and significantly more than those of non-carriers.