title: Risk Factors for Acquisition and Loss of Clostridium difficile Colonization in Hospitalized Patients.
abstract: Asymptomatic colonization may contribute to Clostridium difficile transmission. Few data identify which patients are at risk for colonization. We performed a prospective cohort study of C. difficile colonization and risk factors for C. difficile acquisition and loss in hospitalized patients. Patients admitted to medical or surgical wards at a tertiary care hospital were enrolled; interviews and chart review were performed to determine patient demographics, C. difficile infection (CDI) history, medications, and health care exposures. Stool samples/rectal swabs were collected at enrollment and discharge; stool samples from clinical laboratory tests were also included. Samples were cultured for C. difficile, and the isolates were tested for toxins A and B and ribotyped. Chi-square tests and univariate logistic regression were used for the analyses. Two hundred thirty-five patients were enrolled. Of the patients, 21% were colonized with C. difficile (toxigenic and nontoxigenic) at admission and 24% at discharge. Ribotype 027 accounted for 6% of the strains at admission and 12% at discharge. Of the patients colonized at admission, 78% were also colonized at discharge. Cephalosporin use was associated with C. difficile acquisition (47% of patients who acquired C. difficile versus 25% of patients who did not; P = 0.03). β-lactam-β-lactamase inhibitor combinations were associated with a loss of C. difficile colonization (36% of patients who lost C. difficile colonization versus 8% of patients colonized at both admission and discharge; P = 0.04), as was metronidazole (27% versus 3%; P = 0.03). Antibiotic use affects the epidemiology of asymptomatic C. difficile colonization, including acquisition and loss, and it requires additional study.
authors.affiliation: Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA edubberk@dom.wustl.edu.
authors.forename: Erik R
authors.initials: ER
authors.lastname: Dubberke
authors.affiliation: Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Reske
authors.affiliation: Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Sondra
authors.initials: S
authors.lastname: Seiler
authors.affiliation: Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Hink
authors.affiliation: Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Jennie H
authors.initials: JH
authors.lastname: Kwon
authors.affiliation: Department of Pathology & Immunology and Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Carey-Ann D
authors.identifier: http://orcid.org/0000-0002-1137-840X
authors.initials: CA
authors.lastname: Burnham
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000187:drug effects / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000188:drug therapy / Q000382:microbiology*; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology; D005243:Feces / Q000382:microbiology; D005260:Female; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies; D021521:Ribotyping / Q000379:methods; D012307:Risk Factors; D065093:beta-Lactamase Inhibitors / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D065093:beta-Lactamase Inhibitors