title: Prevalence and risk factors for asymptomatic Clostridium difficile carriage.
abstract: BACKGROUND
  Clostridium difficile infection (CDI) incidence has increased dramatically over the last decade. Recent studies suggest that asymptomatic carriers may be an important reservoir of C. difficile in healthcare settings. We sought to identify the prevalence and risk factors for asymptomatic C. difficile carriage on admission to the hospital.
  
  
  METHODS
  Patients admitted to Barnes-Jewish Hospital without diarrhea were enrolled from June 2010 through October 2011. Demographic information and healthcare and medication exposures 90 days prior to admission were collected. Stool specimens or rectal swabs were collected within 48 hours of admission and stored at -30°C until cultured. Clostridium difficile isolates were typed and compared with isolates from patients with CDI.
  
  
  RESULTS
  A stool/swab specimen was obtained for 259 enrolled subjects on admission. Two hundred four (79%) were not colonized, 40 (15%) had toxigenic C. difficile (TCD), and 15 (6%) had nontoxigenic C. difficile. There were no differences between TCD-colonized and -uncolonized subjects for age (mean, 56 vs 58 years; P = .46), comorbidities, admission from another healthcare facility (33% vs 24%; P = .23), or recent hospitalization (50% vs 50%; P = .43). There were no differences in antimicrobial exposures in the 90 days prior to admission (55% vs 56%; P = .91). Asymptomatic carriers were colonized with strains similar to strains from patients with CDI, but the relative proportions were different.
  
  
  CONCLUSIONS
  There was a high prevalence of TCD colonization on admission. In contrast to past studies, TCD colonization was not associated with recent antimicrobial or healthcare exposures. Additional investigation is needed to determine the role of asymptomatic TCD carriers on hospital-onset CDI incidence.
authors.affiliation: Department of Medicine Department of Medicine, Division of Infectious Diseases, King Fahad Medical City, Riyadh, Saudi Arabia.
authors.forename: Faisal
authors.initials: F
authors.lastname: Alasmari
authors.affiliation: Department of Medicine.
authors.forename: Sondra M
authors.initials: SM
authors.lastname: Seiler
authors.affiliation: Department of Medicine.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Hink
authors.affiliation: Department of Medicine Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Carey-Ann D
authors.initials: CA
authors.lastname: Burnham
authors.affiliation: Department of Medicine.
authors.forename: Erik R
authors.initials: ER
authors.lastname: Dubberke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D016360:Clostridioides difficile / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology; D005243:Feces / Q000382:microbiology; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012007:Rectum / Q000382:microbiology; D012307:Risk Factors; D012529:Saudi Arabia; D055815:Young Adult
keywords: Clostridium difficile colonization; asymptomatic carrier; prevalence; risk factors
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