title: Acquisition of Clostridium difficile by hospitalized patients: evidence for colonized new admissions as a source of infection.
abstract: The frequency of introduction and spread of specific Clostridium difficile strains among hospitalized patients were assessed by serial cultures of patients admitted to a medical-surgical ward with endemic C. difficile-associated diarrhea. Stool cultures were obtained from 634 (94%) of 678 consecutive admissions to the ward (ward admissions), and all C. difficile isolates were typed by restriction endonuclease analysis. Sixty-five ward admissions introduced C. difficile to the ward, and 54 initially culture-negative admissions acquired C. difficile on the ward. Ward admissions hospitalized within the prior 30 days in the medical center were more likely to be culture-positive for C. difficile at admission to the study ward than those not previously hospitalized at the institution (16% vs. 7%, P less than .001). Nosocomial acquisition of a C. difficile strain was preceded by a documented introduction of that strain to the ward by another asymptomatic ward admission in 16 (84%) of 19 instances, suggesting that C. difficile-colonized new admissions are a major source of nosocomial C. difficile infections.
authors.affiliation: Department of Medicine, VA Medical Center, Minneapolis, MN 55417.
authors.forename: C R
authors.initials: CR
authors.lastname: Clabots
authors.forename: S
authors.initials: S
authors.lastname: Johnson
authors.forename: M M
authors.initials: MM
authors.lastname: Olson
authors.forename: L R
authors.initials: LR
authors.lastname: Peterson
authors.forename: D N
authors.initials: DN
authors.lastname: Gerding
mesh_terms: D015373:Bacterial Typing Techniques; D016360:Clostridioides difficile / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D004262:DNA Restriction Enzymes / Q000378:metabolism; D004269:DNA, Bacterial / Q000378:metabolism; D006801:Humans; D007297:Inpatients; D008910:Minnesota / Q000453:epidemiology; D011446:Prospective Studies; D012044:Regression Analysis
chemical_list: D004269:DNA, Bacterial; D004262:DNA Restriction Enzymes