Genotypic correlation between post discharge Clostridiodes difficle infection (CDI) and previous unit-based contacts

• Published in: The Journal of hospital infection 2021-03, Vol.109, p.96-100
• Main Authors: Babady, N.E., Aslam, A., McMillen, T., Syed, M., Zehir, A., Kamboj, M.
• Format: Article
• Language: English
• Subjects: Aftercare; Anti-Bacterial Agents; Clostridioides difficile - genetics; Clostridium difficile; Clostridium Infections - epidemiology; Cross Infection - epidemiology; Genome sequencing; Genotype; Humans; Multilocus Sequence Typing; Patient Discharge; Post-discharge infection; Retrospective Studies
• ISSN: 0195-6701; 1532-2939
• DOI: 10.1016/j.jhin.2020.10.028

Cases of Clostridiodes difficile infection (CDI) diagnosed after hospital discharge account for a substantial proportion of new infections. It is unclear whether post-discharge infections originate from hospital-based transmission. This was a Retrospective cohort study at a tertiary-care cancer center (non-outbreak setting). For all laboratory-identified cases of CDI in 2015–2016, patients with post-discharge (PD) CDI within eight weeks of their hospital stay were included in the study. Isolates from PD-CDI cases and their CDI-positive unit-based contacts were first genotyped by multilocus sequence typing (MLST). Common strains were further examined by core genome sequencing (CGS) to evaluate transmission links. Of 173 cases examined by MLST, 50% of PD cases matched previous unit contacts. Next, 34 isolates, including 16 PD cases and their 18-unit contacts were examined by CGS. None were ≤3 single-nucleotide variants apart. Seventy percent of PD cases had in-hospital antibiotic exposure before CDI onset in the community. Our study results suggest that symptomatic CDI cases are not a substantial source of transmission to PD cases. Frequent antibiotic exposure in post-discharge CDI cases is an important target for surveillance and stewardship efforts.