Evidence of transmission of Clostridium difficile in asymptomatic patients following admission screening in a tertiary care hospital

• Published in: PloS one 2019-02, Vol.14 (2), p.e0207138
• Main Authors: Sheth, Prameet M, Douchant, Katya, Uyanwune, Yvonne, Larocque, Michael, Anantharajah, Arravinth, Borgundvaag, Emily, Dales, Lorraine, McCreight, Liz, McNaught, Laura, Moore, Christine, Ragan, Kelsey, McGeer, Allison, Broukhanski, George
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Analysis; Antibiotics; Antimicrobial agents; Bacteria; Biology and Life Sciences; Carrier State - microbiology; Causes of; Clostridium difficile; Clostridium difficile - isolation & purification; Clostridium Infections - microbiology; Clusters; Colonization; Complications and side effects; Cross infection; Cross Infection - microbiology; Diarrhea; Diarrhea - microbiology; Disease control; Epidemiology; Feces - microbiology; Female; Health aspects; Hospital patients; Hospitalization; Hospitals; Humans; Infections; Infectious diseases; Laboratories; Long term health care; Male; Medical screening; Medicine; Medicine and Health Sciences; Middle Aged; Patients; Prospective Studies; Public health; Rectum; Rectum - microbiology; Research and Analysis Methods; Ribotyping - methods; Studies; Tertiary Care Centers; Typing; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0207138

Clostridium difficile (CD) is the leading cause of infectious health-care associated diarrhea. However, little is known regarding CD carriage and transmission amongst asymptomatic colonizers. We evaluated carriage, characterized strains and examined epidemiologic linkages in asymptomatic colonized CD patients. Rectal swabs from asymptomatic patients admitted to the general medicine ward from April 1-June 30 2012 were collected. PCR-confirmed CD colonies were ribotyped and characterized by Modified-Multi Locus Variable Number Tandem Repeat Analysis (MMLVA). 1549-swabs were collected from 474-patients. Overall, 50/474(10.6%) were CD PCR-positive, 24/50 were colonized at admission, while 26/50 were first identified > = 72 hours after admission. Amongst the 50 CD PCR-positive patients, 90% were asymptomatically colonized and 80% of individuals carried toxigenic CD-strains, including ribotype-027 (5/45:11%). MMLVA revealed five-clusters involving 15-patients harboring toxigenic (4/5) and non-toxigenic CD strains (1/5). In two clusters, patients were CD positive on admission while in the other three clusters involving 10 patients, we observed CD transmission from asymptomatically colonized patients to 8 previously CD-negative patients. We identified increasing rates of colonization during admission to medical wards. MMLVA typing effectively discriminated between strains and suggests that 20% of patients with CD colonization acquired their strain(s) from asymptomatically colonized individuals in hospital.