title: Asymptomatic Clostridium difficile colonization in a tertiary care hospital: admission prevalence and risk factors.
abstract: BACKGROUND
  The role of Clostridium difficile (CD) carriers in health care-associated CD transmission has been identified as an area needing research. We investigated the prevalence of, and risk factors for, asymptomatic CD colonization at hospital admission.
  
  
  METHODS
  Adults admitted to a tertiary care hospital in Minnesota on predetermined study days between March 1 and April 30, 2009, and without symptoms of C difficile infection, were eligible. The first stool sample after admission was requested from each consenting patient and tested for toxigenic CD using polymerase chain reaction (PCR) that detects tcdC. Clinical data were obtained through interviews and chart reviews.
  
  
  RESULTS
  Of 320 participants, 31 (9.7%) were positive for toxigenic CD. Using multivariate logistic regression, independent predictors of CD colonization were recent hospitalization (odds ratio [OR], 2.45; 95% confidence interval [CI]: 1.02-5.84), chronic dialysis (OR, 8.12; 95% CI: 1.80-36.65), and corticosteroid use (OR, 3.09; 95% CI: 1.24-7.73). Screening patients with risk factors (48% participants) would identify 74% (95% CI: 55%-88%) of CD carriers.
  
  
  CONCLUSIONS
  Asymptomatic CD colonization at hospital admission was detected in nearly 1 of 10 patients. The majority of colonized patients had one or more identifiable risk factors. These data could provide the basis for designing studies of targeted surveillance for C difficile.
authors.affiliation: Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA. sleekha@epi.umaryland.edu
authors.forename: Surbhi
authors.initials: S
authors.lastname: Leekha
authors.forename: Kimberly C
authors.initials: KC
authors.lastname: Aronhalt
authors.forename: Lynne M
authors.initials: LM
authors.lastname: Sloan
authors.forename: Robin
authors.initials: R
authors.lastname: Patel
authors.forename: Robert
authors.initials: R
authors.lastname: Orenstein
mesh_terms: D058345:Asymptomatic Infections / Q000453:epidemiology*; D001426:Bacterial Proteins / Q000235:genetics; D016360:Clostridioides difficile / Q000235:genetics; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D005243:Feces / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D016133:Polymerase Chain Reaction; D015995:Prevalence; D012097:Repressor Proteins / Q000235:genetics; D012307:Risk Factors; D062606:Tertiary Care Centers
chemical_list: D001426:Bacterial Proteins; D012097:Repressor Proteins; C105615:TcdC protein, Clostridium difficile