title: The potential for airborne dispersal of Clostridium difficile from symptomatic patients.
abstract: BACKGROUND. The high transmissibility and widespread environmental contamination by Clostridium difficile suggests the possibility of airborne dissemination of spores. We measured airborne and environmental C. difficile adjacent to patients with symptomatic C. difficile infection (CDI). METHODS. We conducted air sampling adjacent to 63 patients with CDI for 180 h in total and for 101 h in control settings. Environmental samples were obtained from surfaces adjacent to the patient and from communal areas of the ward. C. difficile isolates were characterized by ribotyping and multilocus variable-number tandem-repeat analysis to determine relatedness. RESULTS. Of the first 50 patients examined (each for 1 h), only 12% had positive air samples, most frequently those with active symptoms of CDI (10%, vs 2% for those with no symptoms). We intensively sampled the air around 10 patients with CDI symptoms, each for 10 h over 2 days, as well as a total of 346 surface sites. C. difficile was isolated from the air in the majority of these cases (7 of 10 patients tested) and from the surfaces around 9 of the patients; 60% of patients had both air and surface environments that were positive for C. difficile. Molecular characterization confirmed an epidemiological link between airborne dispersal, environmental contamination, and CDI cases. CONCLUSIONS. Aerosolization of C. difficile occurs commonly but sporadically in patients with symptomatic CDI. This may explain the widespread dissemination of epidemic strains. Our results emphasize the importance of single-room isolation as soon as possible after the onset of diarrhea to limit the dissemination of C. difficile.
authors.affiliation: Microbiology Department, Old Medical School, Leeds General Infirmary, Leeds Teaching Hospitals National Health Service Trust, United Kingdom.
authors.forename: Emma L
authors.initials: EL
authors.lastname: Best
authors.forename: Warren N
authors.initials: WN
authors.lastname: Fawley
authors.forename: Peter
authors.initials: P
authors.lastname: Parnell
authors.forename: Mark H
authors.initials: MH
authors.lastname: Wilcox
mesh_terms: D000368:Aged; D015373:Bacterial Typing Techniques; D016360:Clostridioides difficile / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D016000:Cluster Analysis; D003428:Cross Infection / Q000635:transmission*; D016172:DNA Fingerprinting; D004269:DNA, Bacterial / Q000235:genetics; D004761:Enterocolitis, Pseudomembranous / Q000635:transmission*; D004783:Environmental Microbiology; D005838:Genotype; D006801:Humans; D018598:Minisatellite Repeats; D017720:Molecular Epidemiology; D021521:Ribotyping
chemical_list: D004269:DNA, Bacterial