Asymptomatic Clostridium difficile colonization in two Australian tertiary hospitals, 2012-2014: prospective, repeated cross-sectional study

Furuya-Kanamori, L., Clements, A. C. A., Foster, N. F., Huber, C. A., Hong, S., Harris-Brown, T., Yakob, L., Paterson, D. L. and Riley, T. V. (2016) Asymptomatic Clostridium difficile colonization in two Australian tertiary hospitals, 2012-2014: prospective, repeated cross-sectional study. Clinical Microbiology and Infection, 23 1: 48.e1-48.e7. doi:10.1016/j.cmi.2016.08.030


Author Furuya-Kanamori, L.
Clements, A. C. A.
Foster, N. F.
Huber, C. A.
Hong, S.
Harris-Brown, T.
Yakob, L.
Paterson, D. L.
Riley, T. V.
Title Asymptomatic Clostridium difficile colonization in two Australian tertiary hospitals, 2012-2014: prospective, repeated cross-sectional study
Formatted title
Asymptomatic Clostridium difficile colonization in two Australian tertiary hospitals, 2012-2014: prospective, repeated cross-sectional study
Journal name Clinical Microbiology and Infection   Check publisher's open access policy
ISSN 1469-0691
1198-743X
Publication date 2016-09-08
Sub-type Article (original research)
DOI 10.1016/j.cmi.2016.08.030
Open Access Status DOI
Volume 23
Issue 1
Start page 48.e1
End page 48.e7
Total pages 1
Place of publication Oxford, United Kingdom
Publisher Elsevier
Language eng
Formatted abstract
To investigate the prevalence and risk factors for asymptomatic toxigenic (TCD) and nontoxigenic Clostridium difficile (NTCD) colonization in a broad cross section of the general hospital population over a 3-year period.Patients without diarrhoea admitted to two Australian tertiary hospitals were randomly selected through six repeated cross-sectional surveys conducted between 2012 and 2014. Stool specimens were cultured under anaerobic conditions, and C. difficile isolates were tested for the presence of toxin genes and ribotyped. Patients were then grouped into noncolonized, TCD colonized or NTCD colonized for identifying risk factors using multinomial logistic regression models.A total of 1380 asymptomatic patients were enrolled; 76 patients (5.5%) were TCD colonized and 28 (2.0%) were NTCD colonized. There was a decreasing annual trend in TCD colonization, and asymptomatic colonization was more prevalent during the summer than winter months. TCD colonization was associated with gastro-oesophageal reflux disease (relative risk ratio (RRR) = 2.20; 95% confidence interval (CI) 1.17-4.14), higher number of admissions in the previous year (RRR = 1.24; 95% CI 1.10-1.39) and antimicrobial exposure during the current admission (RRR = 2.78; 95% CI 1.23-6.28). NTCD colonization was associated with chronic obstructive pulmonary disease (RRR = 3.88; 95% CI 1.66-9.07) and chronic kidney failure (RRR = 5.78; 95% CI 2.29-14.59). Forty-eight different ribotypes were identified, with 014/020 (n = 23), 018 (n = 10) and 056 (n = 6) being the most commonly isolated.Risk factors differ between patients with asymptomatic colonization by toxigenic and nontoxigenic strains. Given that morbidity is largely driven by toxigenic strains, this novel finding has important implications for disease control and prevention.
Keyword Asymptomatic
Clostridium difficile
Colonization
Prevalence
Toxigenic
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: UQ Centre for Clinical Research Publications
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