Screening of Clostridioides difficile carriers in an urban academic medical center: Understanding implications of disease
Efforts to reduce Clostridioides difficile infection (CDI) have targeted transmission from patients with symptomatic C. difficile. However, many patients with the C. difficile organism are carriers without symptoms who may serve as reservoirs for spread of infection and may be at risk for progressio...
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| Veröffentlicht in: | Infection control and hospital epidemiology 2020-02, Vol.41 (2), p.149-5 |
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| creator | Baron, Sarah W Ostrowsky, Belinda E Nori, Priya Drory, David Y Levi, Michael H Szymczak, Wendy A Rinke, Michael L Southern, William N |
| description | Efforts to reduce Clostridioides difficile infection (CDI) have targeted transmission from patients with symptomatic C. difficile. However, many patients with the C. difficile organism are carriers without symptoms who may serve as reservoirs for spread of infection and may be at risk for progression to symptomatic C. difficile. To estimate the prevalence of C. difficile carriage and determine the risk and speed of progression to symptomatic C. difficile among carriers, we established a pilot screening program in a large urban hospital.
Prospective cohort study.
An 800-bed, tertiary-care, academic medical center in the Bronx, New York.
A sample of admitted adults without diarrhea, with oversampling of nursing facility patients.
Perirectal swabs were tested by polymerase chain reaction for C. difficile within 24 hours of admission, and patients were followed for progression to symptomatic C. difficile. Development of symptomatic C. difficile was compared among C. difficile carriers and noncarriers using a Cox proportional hazards model.
Of the 220 subjects, 21 (9.6%) were C. difficile carriers, including 10.2% of the nursing facility residents and 7.7% of the community residents (P = .60). Among the 21 C. difficile carriers, 8 (38.1%) progressed to symptomatic C. difficile, but only 4 (2.0%) of the 199 noncarriers progressed to symptomatic C. difficile (hazard ratio, 23.9; 95% CI, 7.2-79.6; P < .0001).
Asymptomatic carriage of C. difficile is prevalent among admitted patients and confers a significant risk of progression to symptomatic CDI. Screening for asymptomatic carriers may represent an opportunity to reduce CDI. |
| doi_str_mv | 10.1017/ice.2019.309 |
| format | Article |
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Prospective cohort study.
An 800-bed, tertiary-care, academic medical center in the Bronx, New York.
A sample of admitted adults without diarrhea, with oversampling of nursing facility patients.
Perirectal swabs were tested by polymerase chain reaction for C. difficile within 24 hours of admission, and patients were followed for progression to symptomatic C. difficile. Development of symptomatic C. difficile was compared among C. difficile carriers and noncarriers using a Cox proportional hazards model.
Of the 220 subjects, 21 (9.6%) were C. difficile carriers, including 10.2% of the nursing facility residents and 7.7% of the community residents (P = .60). Among the 21 C. difficile carriers, 8 (38.1%) progressed to symptomatic C. difficile, but only 4 (2.0%) of the 199 noncarriers progressed to symptomatic C. difficile (hazard ratio, 23.9; 95% CI, 7.2-79.6; P < .0001).
Asymptomatic carriage of C. difficile is prevalent among admitted patients and confers a significant risk of progression to symptomatic CDI. Screening for asymptomatic carriers may represent an opportunity to reduce CDI.</description><identifier>ISSN: 0899-823X</identifier><identifier>ISSN: 1559-6834</identifier><identifier>EISSN: 1559-6834</identifier><identifier>DOI: 10.1017/ice.2019.309</identifier><identifier>PMID: 31822302</identifier><language>eng</language><publisher>United States: Cambridge University Press</publisher><subject>Academic Medical Centers ; Adult ; Aged ; Aged, 80 and over ; Antibiotics ; Asymptomatic ; Carrier State - diagnosis ; Carrier State - epidemiology ; Clostridioides difficile - isolation & purification ; Clostridium Infections - diagnosis ; Clostridium Infections - epidemiology ; Diarrhea ; Electronic health records ; Feces - microbiology ; Female ; Hospitalization ; Hospitals ; Humans ; Kaplan-Meier Estimate ; Male ; Medical records ; Middle Aged ; New York - epidemiology ; Nosocomial infections ; Nursing ; Patients ; Polymerase Chain Reaction ; Prevalence ; Proportional Hazards Models ; Prospective Studies ; Young Adult</subject><ispartof>Infection control and hospital epidemiology, 2020-02, Vol.41 (2), p.149-5</ispartof><rights>2019 by The Society for Healthcare Epidemiology of America. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c374t-3b877ff445c8568c4ac35d45f5e0b8e7f23082603eec9e51ebd8774406a2c5cd3</citedby><cites>FETCH-LOGICAL-c374t-3b877ff445c8568c4ac35d45f5e0b8e7f23082603eec9e51ebd8774406a2c5cd3</cites><orcidid>0000-0002-5714-3139</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2844771954/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$H</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2844771954?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>230,315,781,785,886,21390,21391,23258,27926,27927,33532,33533,33705,33706,33746,33747,43661,43789,43807,64387,64389,64391,72471,74106,74285,74304</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31822302$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Baron, Sarah W</creatorcontrib><creatorcontrib>Ostrowsky, Belinda E</creatorcontrib><creatorcontrib>Nori, Priya</creatorcontrib><creatorcontrib>Drory, David Y</creatorcontrib><creatorcontrib>Levi, Michael H</creatorcontrib><creatorcontrib>Szymczak, Wendy A</creatorcontrib><creatorcontrib>Rinke, Michael L</creatorcontrib><creatorcontrib>Southern, William N</creatorcontrib><title>Screening of Clostridioides difficile carriers in an urban academic medical center: Understanding implications of disease</title><title>Infection control and hospital epidemiology</title><addtitle>Infect Control Hosp Epidemiol</addtitle><description>Efforts to reduce Clostridioides difficile infection (CDI) have targeted transmission from patients with symptomatic C. difficile. However, many patients with the C. difficile organism are carriers without symptoms who may serve as reservoirs for spread of infection and may be at risk for progression to symptomatic C. difficile. To estimate the prevalence of C. difficile carriage and determine the risk and speed of progression to symptomatic C. difficile among carriers, we established a pilot screening program in a large urban hospital.
Prospective cohort study.
An 800-bed, tertiary-care, academic medical center in the Bronx, New York.
A sample of admitted adults without diarrhea, with oversampling of nursing facility patients.
Perirectal swabs were tested by polymerase chain reaction for C. difficile within 24 hours of admission, and patients were followed for progression to symptomatic C. difficile. Development of symptomatic C. difficile was compared among C. difficile carriers and noncarriers using a Cox proportional hazards model.
Of the 220 subjects, 21 (9.6%) were C. difficile carriers, including 10.2% of the nursing facility residents and 7.7% of the community residents (P = .60). Among the 21 C. difficile carriers, 8 (38.1%) progressed to symptomatic C. difficile, but only 4 (2.0%) of the 199 noncarriers progressed to symptomatic C. difficile (hazard ratio, 23.9; 95% CI, 7.2-79.6; P < .0001).
Asymptomatic carriage of C. difficile is prevalent among admitted patients and confers a significant risk of progression to symptomatic CDI. Screening for asymptomatic carriers may represent an opportunity to reduce CDI.</description><subject>Academic Medical Centers</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antibiotics</subject><subject>Asymptomatic</subject><subject>Carrier State - diagnosis</subject><subject>Carrier State - epidemiology</subject><subject>Clostridioides difficile - isolation & purification</subject><subject>Clostridium Infections - diagnosis</subject><subject>Clostridium Infections - epidemiology</subject><subject>Diarrhea</subject><subject>Electronic health records</subject><subject>Feces - microbiology</subject><subject>Female</subject><subject>Hospitalization</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Medical records</subject><subject>Middle Aged</subject><subject>New York - epidemiology</subject><subject>Nosocomial infections</subject><subject>Nursing</subject><subject>Patients</subject><subject>Polymerase Chain Reaction</subject><subject>Prevalence</subject><subject>Proportional Hazards Models</subject><subject>Prospective Studies</subject><subject>Young Adult</subject><issn>0899-823X</issn><issn>1559-6834</issn><issn>1559-6834</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNpdkc1rFTEUxYMo9rW6cy0BNy46z3xOEhcFefgFBRdacBcyyZ2aMpM8kxmh_70ZWou6uVncX849h4PQC0r2lFD1JnrYM0LNnhPzCO2olKbrNReP0Y5oYzrN-PcTdFrrDSFEGUOfohNONWOcsB26_eoLQIrpGucRH6ZclxJDzDFAxSGOY_RxAuxdKRFKxTFhl_BahjaddwHm6PEMIXo3YQ9pgfIWX6XQ2MWlsOnG-Ti19RJzqtuRECu4Cs_Qk9FNFZ7fv2fo6sP7b4dP3eWXj58P7y47z5VYOj5opcZRCOm17LUXznMZhBwlkEGDGlsOzXrCAbwBSWEI7YMQpHfMSx_4Gbq40z2uQzO6eSxusscSZ1dubXbR_rtJ8Ye9zr-sUoQxw5vA63uBkn-uUBc7x-phmlyCvFbLOBOG9qJnDX31H3qT15JaPMu0EEpRI0Wjzu8oX3KtBcYHM5TYrVPbOrVbp7Z12vCXfwd4gP-UyH8DtVSflg</recordid><startdate>20200201</startdate><enddate>20200201</enddate><creator>Baron, Sarah W</creator><creator>Ostrowsky, Belinda E</creator><creator>Nori, Priya</creator><creator>Drory, David Y</creator><creator>Levi, Michael H</creator><creator>Szymczak, Wendy A</creator><creator>Rinke, Michael L</creator><creator>Southern, William N</creator><general>Cambridge University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>S0X</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-5714-3139</orcidid></search><sort><creationdate>20200201</creationdate><title>Screening of Clostridioides difficile carriers in an urban academic medical center: Understanding implications of disease</title><author>Baron, Sarah W ; Ostrowsky, Belinda E ; Nori, Priya ; Drory, David Y ; Levi, Michael H ; Szymczak, Wendy A ; Rinke, Michael L ; Southern, William N</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c374t-3b877ff445c8568c4ac35d45f5e0b8e7f23082603eec9e51ebd8774406a2c5cd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Academic Medical Centers</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Antibiotics</topic><topic>Asymptomatic</topic><topic>Carrier State - diagnosis</topic><topic>Carrier State - epidemiology</topic><topic>Clostridioides difficile - isolation & purification</topic><topic>Clostridium Infections - diagnosis</topic><topic>Clostridium Infections - epidemiology</topic><topic>Diarrhea</topic><topic>Electronic health records</topic><topic>Feces - microbiology</topic><topic>Female</topic><topic>Hospitalization</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Medical records</topic><topic>Middle Aged</topic><topic>New York - epidemiology</topic><topic>Nosocomial infections</topic><topic>Nursing</topic><topic>Patients</topic><topic>Polymerase Chain Reaction</topic><topic>Prevalence</topic><topic>Proportional Hazards Models</topic><topic>Prospective Studies</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Baron, Sarah W</creatorcontrib><creatorcontrib>Ostrowsky, Belinda E</creatorcontrib><creatorcontrib>Nori, Priya</creatorcontrib><creatorcontrib>Drory, David Y</creatorcontrib><creatorcontrib>Levi, Michael H</creatorcontrib><creatorcontrib>Szymczak, Wendy A</creatorcontrib><creatorcontrib>Rinke, Michael L</creatorcontrib><creatorcontrib>Southern, William N</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Infection control and hospital epidemiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Baron, Sarah W</au><au>Ostrowsky, Belinda E</au><au>Nori, Priya</au><au>Drory, David Y</au><au>Levi, Michael H</au><au>Szymczak, Wendy A</au><au>Rinke, Michael L</au><au>Southern, William N</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Screening of Clostridioides difficile carriers in an urban academic medical center: Understanding implications of disease</atitle><jtitle>Infection control and hospital epidemiology</jtitle><addtitle>Infect Control Hosp Epidemiol</addtitle><date>2020-02-01</date><risdate>2020</risdate><volume>41</volume><issue>2</issue><spage>149</spage><epage>5</epage><pages>149-5</pages><issn>0899-823X</issn><issn>1559-6834</issn><eissn>1559-6834</eissn><abstract>Efforts to reduce Clostridioides difficile infection (CDI) have targeted transmission from patients with symptomatic C. difficile. However, many patients with the C. difficile organism are carriers without symptoms who may serve as reservoirs for spread of infection and may be at risk for progression to symptomatic C. difficile. To estimate the prevalence of C. difficile carriage and determine the risk and speed of progression to symptomatic C. difficile among carriers, we established a pilot screening program in a large urban hospital.
Prospective cohort study.
An 800-bed, tertiary-care, academic medical center in the Bronx, New York.
A sample of admitted adults without diarrhea, with oversampling of nursing facility patients.
Perirectal swabs were tested by polymerase chain reaction for C. difficile within 24 hours of admission, and patients were followed for progression to symptomatic C. difficile. Development of symptomatic C. difficile was compared among C. difficile carriers and noncarriers using a Cox proportional hazards model.
Of the 220 subjects, 21 (9.6%) were C. difficile carriers, including 10.2% of the nursing facility residents and 7.7% of the community residents (P = .60). Among the 21 C. difficile carriers, 8 (38.1%) progressed to symptomatic C. difficile, but only 4 (2.0%) of the 199 noncarriers progressed to symptomatic C. difficile (hazard ratio, 23.9; 95% CI, 7.2-79.6; P < .0001).
Asymptomatic carriage of C. difficile is prevalent among admitted patients and confers a significant risk of progression to symptomatic CDI. Screening for asymptomatic carriers may represent an opportunity to reduce CDI.</abstract><cop>United States</cop><pub>Cambridge University Press</pub><pmid>31822302</pmid><doi>10.1017/ice.2019.309</doi><tpages>5</tpages><orcidid>https://orcid.org/0000-0002-5714-3139</orcidid></addata></record> |
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| subjects | Academic Medical Centers Adult Aged Aged, 80 and over Antibiotics Asymptomatic Carrier State - diagnosis Carrier State - epidemiology Clostridioides difficile - isolation & purification Clostridium Infections - diagnosis Clostridium Infections - epidemiology Diarrhea Electronic health records Feces - microbiology Female Hospitalization Hospitals Humans Kaplan-Meier Estimate Male Medical records Middle Aged New York - epidemiology Nosocomial infections Nursing Patients Polymerase Chain Reaction Prevalence Proportional Hazards Models Prospective Studies Young Adult |
| title | Screening of Clostridioides difficile carriers in an urban academic medical center: Understanding implications of disease |
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