title: Clinical impact of Clostridium difficile colonization.
abstract: Clostridium difﬁcile can cause antibiotic-associated diarrhea in hospitalized patients. Asymptomatic colonization by C. difficile is common during the neonatal period and early infancy, ranging from 21% to 48%, and in childhood. The colonization rate of C. difficile in adult hospitalized patients shows geographic variation, ranging from 4.4% to 23.2%. Asymptomatic carriage in neonates caused no further disease in many studies, whereas adult patients colonized with toxigenic C. difficile were prone to the subsequent development of C. difficile-associated diarrhea (CDAD). However, the carriage of nontoxigenic C. difficile strains appears to prevent CDAD in hamsters and humans. Risk factors for C. difficile colonization include recent hospitalization, exposure to antimicrobial agents or gastric acid-suppressing drugs (such as proton-pump inhibitors and H2 blockers), a history of CDAD or cytomegalovirus infection, the presence of an underlying illness, receipt of immunosuppressants, the presence of antibodies against toxin B, and Toll-like receptor 4 polymorphisms. Asymptomatic C. difficile carriers are associated with significant skin and environmental contamination, similar to those with CDAD, and contact isolation and hand-washing practices should therefore be employed as infection control policies for the prevention of C. difficile spread. Treating patients with asymptomatic C. difficile colonization with metronidazole or vancomycin is not suggested by the currently available evidence. In conclusion, asymptomatic C. difficile colonization may lead to skin and environmental contamination by C. difficile, but more attention should be paid to the clinical impact of those with C. difficile colonization.
authors.affiliation: Department of Internal Medicine, Ministry of Health & Welfare, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University, Medical College and Hospital, Tainan, Taiwan; Graduate Institute of Clinical Medicine, National Health Research Institutes, Tainan, Taiwan.
authors.forename: Yuan-Pin
authors.initials: YP
authors.lastname: Hung
authors.affiliation: Department of Internal Medicine, National Cheng Kung University, Medical College and Hospital, Tainan, Taiwan.
authors.forename: Jen-Chieh
authors.initials: JC
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Ministry of Health & Welfare, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University, Medical College and Hospital, Tainan, Taiwan; Graduate Institute of Clinical Medicine, National Health Research Institutes, Tainan, Taiwan.
authors.forename: Hsiao-Ju
authors.initials: HJ
authors.lastname: Lin
authors.affiliation: Department of Internal Medicine, Ministry of Health & Welfare, Tainan, Taiwan.
authors.forename: Hsiao-Chieh
authors.initials: HC
authors.lastname: Liu
authors.affiliation: Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan.
authors.forename: Yi-Hui
authors.initials: YH
authors.lastname: Wu
authors.affiliation: Department of Medical Laboratory Science and Biotechnology, National Cheng Kung University, Medical College, Tainan, Taiwan; Center of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan, Taiwan. Electronic address: peijtsai@mail.ncku.edu.com.
authors.forename: Pei-Jane
authors.initials: PJ
authors.lastname: Tsai
authors.affiliation: Department of Internal Medicine, National Cheng Kung University, Medical College and Hospital, Tainan, Taiwan. Electronic address: winston3415@gmail.com.
authors.forename: Wen-Chien
authors.initials: WC
authors.lastname: Ko
mesh_terms: D000818:Animals; D001427:Bacterial Toxins / Q000378:metabolism; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology; D006224:Cricetinae; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology; D004195:Disease Models, Animal; D006801:Humans; D015994:Incidence; D015995:Prevalence; D012307:Risk Factors
chemical_list: D001427:Bacterial Toxins
keywords: C. difficile-associated diarrhea; Clostridium difﬁcile colonization; Environment contamination; Nontoxigenic C. difficile; Risk factor; Toxigenic C. difficile