Asymptomatic carriers of toxigenic C. difficile in long-term care facilities: a meta-analysis of prevalence and risk factors
The impact of Clostridium difficile colonization in C. difficile infection (CDI) is inadequately explored. As a result, asymptomatic carriage is not considered in the development of infection control policies and the burden of carrier state in long-term care facilities (LTCFs) is unknown. To explore...
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| description | The impact of Clostridium difficile colonization in C. difficile infection (CDI) is inadequately explored. As a result, asymptomatic carriage is not considered in the development of infection control policies and the burden of carrier state in long-term care facilities (LTCFs) is unknown.
To explore the epidemiology of C. difficile colonization in LTCFs, identify predisposing factors and describe its impact on healthcare management.
PubMed, Embase and Web of Science (up to June 2014) without language restriction, complemented by reference lists of eligible studies.
All studies providing extractable data on the prevalence of toxigenic C. difficile colonization among asymptomatic residents in LTCFs.
Two authors extracted data independently.
The pooled colonization estimates were calculated using the double arcsine methodology and reported along with their 95% random-effects confidence intervals (CIs), using DerSimonian-Laird weights. We assessed the impact of patient-level covariates on the risk of colonization and effects were reported as odds ratios (OR, 95% CI). We used the colonization estimates to simulate the effective reproduction number R through a Monte Carlo technique.
Based on data from 9 eligible studies that met the specified criteria and included 1,371 subjects, we found that 14.8% (95%CI 7.6%-24.0%) of LTCF residents are asymptomatic carriers of toxigenic C. difficile. Colonization estimates were significantly higher in facilities with prior CDI outbreak (30.1% vs. 6.5%, p = 0.01). Patient history of CDI (OR 6.07; 95% CI 2.06-17.88; effect derived from 3 studies), prior hospitalization (OR 2.11; 95% CI 1.08-4.13; derived from 3 studies) and antimicrobial use within previous 3 months (OR 3.68; 95% CI 2.04-6.62; derived from 4 studies) were associated with colonization. The predicted colonization rate at admission was 8.9%.
Asymptomatic carriage of toxigenic C. difficile represents a significant burden in LTCFs and is associated with prior CDI outbreaks in the facility, a history of CDI, prior hospitalization and antimicrobial use. These findings can impact infection control measures at LTCFs. |
| doi_str_mv | 10.1371/journal.pone.0117195 |
| format | Article |
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To explore the epidemiology of C. difficile colonization in LTCFs, identify predisposing factors and describe its impact on healthcare management.
PubMed, Embase and Web of Science (up to June 2014) without language restriction, complemented by reference lists of eligible studies.
All studies providing extractable data on the prevalence of toxigenic C. difficile colonization among asymptomatic residents in LTCFs.
Two authors extracted data independently.
The pooled colonization estimates were calculated using the double arcsine methodology and reported along with their 95% random-effects confidence intervals (CIs), using DerSimonian-Laird weights. We assessed the impact of patient-level covariates on the risk of colonization and effects were reported as odds ratios (OR, 95% CI). We used the colonization estimates to simulate the effective reproduction number R through a Monte Carlo technique.
Based on data from 9 eligible studies that met the specified criteria and included 1,371 subjects, we found that 14.8% (95%CI 7.6%-24.0%) of LTCF residents are asymptomatic carriers of toxigenic C. difficile. Colonization estimates were significantly higher in facilities with prior CDI outbreak (30.1% vs. 6.5%, p = 0.01). Patient history of CDI (OR 6.07; 95% CI 2.06-17.88; effect derived from 3 studies), prior hospitalization (OR 2.11; 95% CI 1.08-4.13; derived from 3 studies) and antimicrobial use within previous 3 months (OR 3.68; 95% CI 2.04-6.62; derived from 4 studies) were associated with colonization. The predicted colonization rate at admission was 8.9%.
Asymptomatic carriage of toxigenic C. difficile represents a significant burden in LTCFs and is associated with prior CDI outbreaks in the facility, a history of CDI, prior hospitalization and antimicrobial use. These findings can impact infection control measures at LTCFs.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0117195</identifier><identifier>PMID: 25707002</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Antibiotics ; Antiinfectives and antibacterials ; Carrier State - epidemiology ; Carriers ; Clostridium difficile ; Colonization ; Computer simulation ; Confidence intervals ; Cross infection ; Databases, Factual ; Development and progression ; Diarrhea ; Disease control ; Enterocolitis, Pseudomembranous - epidemiology ; Enterocolitis, Pseudomembranous - transmission ; Epidemiology ; Estimates ; Health aspects ; Health care ; Humans ; Infection Control ; Infections ; Infectious diseases ; Long term care ; Long term care facilities ; Long term health care ; Medical schools ; Meta-analysis ; Nursing homes ; Older people ; Outbreaks ; Population ; Prevalence ; Prevalence studies (Epidemiology) ; Quality ; Risk analysis ; Risk Factors ; Statistical analysis ; Statistical methods ; Studies ; Transplants & implants</subject><ispartof>PloS one, 2015-02, Vol.10 (2), p.e0117195</ispartof><rights>COPYRIGHT 2015 Public Library of Science</rights><rights>2015 Ziakas et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2015 Ziakas et al 2015 Ziakas et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-fedaa652686aaa266fe71b7fb4dae957b4248c2274096ab6b0564b7811d471913</citedby><cites>FETCH-LOGICAL-c692t-fedaa652686aaa266fe71b7fb4dae957b4248c2274096ab6b0564b7811d471913</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4338134/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4338134/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79569,79570</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25707002$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ziakas, Panayiotis D</creatorcontrib><creatorcontrib>Zacharioudakis, Ioannis M</creatorcontrib><creatorcontrib>Zervou, Fainareti N</creatorcontrib><creatorcontrib>Grigoras, Christos</creatorcontrib><creatorcontrib>Pliakos, Elina Eleftheria</creatorcontrib><creatorcontrib>Mylonakis, Eleftherios</creatorcontrib><title>Asymptomatic carriers of toxigenic C. difficile in long-term care facilities: a meta-analysis of prevalence and risk factors</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>The impact of Clostridium difficile colonization in C. difficile infection (CDI) is inadequately explored. As a result, asymptomatic carriage is not considered in the development of infection control policies and the burden of carrier state in long-term care facilities (LTCFs) is unknown.
To explore the epidemiology of C. difficile colonization in LTCFs, identify predisposing factors and describe its impact on healthcare management.
PubMed, Embase and Web of Science (up to June 2014) without language restriction, complemented by reference lists of eligible studies.
All studies providing extractable data on the prevalence of toxigenic C. difficile colonization among asymptomatic residents in LTCFs.
Two authors extracted data independently.
The pooled colonization estimates were calculated using the double arcsine methodology and reported along with their 95% random-effects confidence intervals (CIs), using DerSimonian-Laird weights. We assessed the impact of patient-level covariates on the risk of colonization and effects were reported as odds ratios (OR, 95% CI). We used the colonization estimates to simulate the effective reproduction number R through a Monte Carlo technique.
Based on data from 9 eligible studies that met the specified criteria and included 1,371 subjects, we found that 14.8% (95%CI 7.6%-24.0%) of LTCF residents are asymptomatic carriers of toxigenic C. difficile. Colonization estimates were significantly higher in facilities with prior CDI outbreak (30.1% vs. 6.5%, p = 0.01). Patient history of CDI (OR 6.07; 95% CI 2.06-17.88; effect derived from 3 studies), prior hospitalization (OR 2.11; 95% CI 1.08-4.13; derived from 3 studies) and antimicrobial use within previous 3 months (OR 3.68; 95% CI 2.04-6.62; derived from 4 studies) were associated with colonization. The predicted colonization rate at admission was 8.9%.
Asymptomatic carriage of toxigenic C. difficile represents a significant burden in LTCFs and is associated with prior CDI outbreaks in the facility, a history of CDI, prior hospitalization and antimicrobial use. These findings can impact infection control measures at LTCFs.</description><subject>Antibiotics</subject><subject>Antiinfectives and antibacterials</subject><subject>Carrier State - epidemiology</subject><subject>Carriers</subject><subject>Clostridium difficile</subject><subject>Colonization</subject><subject>Computer simulation</subject><subject>Confidence intervals</subject><subject>Cross infection</subject><subject>Databases, Factual</subject><subject>Development and progression</subject><subject>Diarrhea</subject><subject>Disease control</subject><subject>Enterocolitis, Pseudomembranous - epidemiology</subject><subject>Enterocolitis, Pseudomembranous - transmission</subject><subject>Epidemiology</subject><subject>Estimates</subject><subject>Health aspects</subject><subject>Health care</subject><subject>Humans</subject><subject>Infection Control</subject><subject>Infections</subject><subject>Infectious diseases</subject><subject>Long term care</subject><subject>Long term care facilities</subject><subject>Long term health care</subject><subject>Medical schools</subject><subject>Meta-analysis</subject><subject>Nursing homes</subject><subject>Older people</subject><subject>Outbreaks</subject><subject>Population</subject><subject>Prevalence</subject><subject>Prevalence studies (Epidemiology)</subject><subject>Quality</subject><subject>Risk analysis</subject><subject>Risk Factors</subject><subject>Statistical analysis</subject><subject>Statistical methods</subject><subject>Studies</subject><subject>Transplants & 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Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ziakas, Panayiotis D</au><au>Zacharioudakis, Ioannis M</au><au>Zervou, Fainareti N</au><au>Grigoras, Christos</au><au>Pliakos, Elina Eleftheria</au><au>Mylonakis, Eleftherios</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Asymptomatic carriers of toxigenic C. difficile in long-term care facilities: a meta-analysis of prevalence and risk factors</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2015-02-23</date><risdate>2015</risdate><volume>10</volume><issue>2</issue><spage>e0117195</spage><pages>e0117195-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>The impact of Clostridium difficile colonization in C. difficile infection (CDI) is inadequately explored. As a result, asymptomatic carriage is not considered in the development of infection control policies and the burden of carrier state in long-term care facilities (LTCFs) is unknown.
To explore the epidemiology of C. difficile colonization in LTCFs, identify predisposing factors and describe its impact on healthcare management.
PubMed, Embase and Web of Science (up to June 2014) without language restriction, complemented by reference lists of eligible studies.
All studies providing extractable data on the prevalence of toxigenic C. difficile colonization among asymptomatic residents in LTCFs.
Two authors extracted data independently.
The pooled colonization estimates were calculated using the double arcsine methodology and reported along with their 95% random-effects confidence intervals (CIs), using DerSimonian-Laird weights. We assessed the impact of patient-level covariates on the risk of colonization and effects were reported as odds ratios (OR, 95% CI). We used the colonization estimates to simulate the effective reproduction number R through a Monte Carlo technique.
Based on data from 9 eligible studies that met the specified criteria and included 1,371 subjects, we found that 14.8% (95%CI 7.6%-24.0%) of LTCF residents are asymptomatic carriers of toxigenic C. difficile. Colonization estimates were significantly higher in facilities with prior CDI outbreak (30.1% vs. 6.5%, p = 0.01). Patient history of CDI (OR 6.07; 95% CI 2.06-17.88; effect derived from 3 studies), prior hospitalization (OR 2.11; 95% CI 1.08-4.13; derived from 3 studies) and antimicrobial use within previous 3 months (OR 3.68; 95% CI 2.04-6.62; derived from 4 studies) were associated with colonization. The predicted colonization rate at admission was 8.9%.
Asymptomatic carriage of toxigenic C. difficile represents a significant burden in LTCFs and is associated with prior CDI outbreaks in the facility, a history of CDI, prior hospitalization and antimicrobial use. These findings can impact infection control measures at LTCFs.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>25707002</pmid><doi>10.1371/journal.pone.0117195</doi><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2015-02, Vol.10 (2), p.e0117195 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_1658065725 |
| source | PubMed Central (Open Access); MEDLINE; Public Library of Science; Free E-Journal (出版社公開部分のみ）; Free Full-Text Journals in Chemistry; Directory of Open Access Journals (Open Access) |
| subjects | Antibiotics Antiinfectives and antibacterials Carrier State - epidemiology Carriers Clostridium difficile Colonization Computer simulation Confidence intervals Cross infection Databases, Factual Development and progression Diarrhea Disease control Enterocolitis, Pseudomembranous - epidemiology Enterocolitis, Pseudomembranous - transmission Epidemiology Estimates Health aspects Health care Humans Infection Control Infections Infectious diseases Long term care Long term care facilities Long term health care Medical schools Meta-analysis Nursing homes Older people Outbreaks Population Prevalence Prevalence studies (Epidemiology) Quality Risk analysis Risk Factors Statistical analysis Statistical methods Studies Transplants & implants |
| title | Asymptomatic carriers of toxigenic C. difficile in long-term care facilities: a meta-analysis of prevalence and risk factors |
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