Predictors of asymptomatic Clostridium difficile colonization on hospital admission.
BACKGROUND
Clostridium difficile (CD) is the leading cause of health care-associated diarrhea and can result in asymptomatic carriage. Rates of asymptomatic CD colonization on hospital admission range from 1.4%-21%. The objective of this study was to evaluate host and bacterial factors associated with colonization on admission.


METHODS
The Consortium de recherche québécois sur le Clostridium difficile study provided data for analysis, including demographic information, known risk factors, and potential confounding factors, prospectively collected for 5,232 patients from 6 hospitals in Quebec and Ontario over 15 months from 2006-2007. Stool or rectal swabs were obtained for culture on admission. Pulsed-field gel electrophoresis was performed on the isolates. The presence of antibody against CD toxins A and B was measured.


RESULTS
There were 212 (4.05%) patients colonized with CD on admission, and 5,020 patients were not colonized with CD. Multivariate logistic regression analysis showed that hospitalization within the last 12 months, use of corticosteroids, prior CD infection, and presence of antibody against toxin B were associated with colonization on admission. Of patients colonized on admission, 79.4% had non-NAP1, non-NAP2 strains.


CONCLUSIONS
There are identifiable risk factors among asymptomatic CD carriers that could serve in their detection and provide a basis for targeted screening.
McGill University Health Centre, McGill University, Montréal, QC, Canada.
Ling Yuan
LY
Kong
McGill University Health Centre, McGill University, Montréal, QC, Canada.
Nandini
N
Dendukuri
McGill University Health Centre, McGill University, Montréal, QC, Canada.
Ian
I
Schiller
McGill University Health Centre, McGill University, Montréal, QC, Canada; Centre Hospitalier Universitaire de Montréal, Université de Montréal, Montréal, QC, Canada.
Anne-Marie
AM
Bourgault
McGill University Health Centre, McGill University, Montréal, QC, Canada.
Paul
P
Brassard
Centre Hospitalier Universitaire de Montréal, Université de Montréal, Montréal, QC, Canada.
Louise
L
Poirier
Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada.
François
F
Lamothe
Centre Hospitalier Universitaire de Montréal, Université de Montréal, Montréal, QC, Canada.
Claire
C
Béliveau
Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada.
Sophie
S
Michaud
Centre Hospitalier Universitaire de Québec-Hôtel-Dieu de Québec, Université Laval, Québec, QC, Canada.
Nathalie
N
Turgeon
Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
Baldwin
B
Toye
Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada.
Eric H
EH
Frost
Université Laval, Québec, QC, Canada; Institut national de santé publique du Québec, Québec, QC, Canada.
Rodica
R
Gilca
Jewish General Hospital, McGill University, Montréal, QC, Canada.
Andre
A
Dascal
McGill University Health Centre, McGill University, Montréal, QC, Canada. Electronic address: vivian.loo@muhc.mcgill.ca.
Vivian G
VG
Loo
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058345:Asymptomatic Infections / Q000453:epidemiology*; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000175:diagnosis* / Q000453:epidemiology*; D016521:Electrophoresis, Gel, Pulsed-Field; D005243:Feces / Q000382:microbiology; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D011792:Quebec / Q000453:epidemiology; D012007:Rectum / Q000382:microbiology; D012307:Risk Factors; D055815:Young Adult
Clostridium difficile; Colonization; Predictors; Risk factors