title: Quantifying Transmission of Clostridium difficile within and outside Healthcare Settings.
abstract: To quantify the effect of hospital and community-based transmission and control measures on Clostridium difficile infection (CDI), we constructed a transmission model within and between hospital, community, and long-term care-facility settings. By parameterizing the model from national databases and calibrating it to C. difficile prevalence and CDI incidence, we found that hospitalized patients with CDI transmit C. difficile at a rate 15 (95% CI 7.2-32) times that of asymptomatic patients. Long-term care facility residents transmit at a rate of 27% (95% CI 13%-51%) that of hospitalized patients, and persons in the community at a rate of 0.1% (95% CI 0.062%-0.2%) that of hospitalized patients. Despite lower transmission rates for asymptomatic carriers and community sources, these transmission routes have a substantial effect on hospital-onset CDI because of the larger reservoir of hospitalized carriers and persons in the community. Asymptomatic carriers and community sources should be accounted for when designing and evaluating control interventions.
authors.forename: David P
authors.initials: DP
authors.lastname: Durham
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Olsen
authors.forename: Erik R
authors.initials: ER
authors.lastname: Dubberke
authors.forename: Alison P
authors.initials: AP
authors.lastname: Galvani
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Townsend
mesh_terms: D000368:Aged; D002353:Carrier State / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*; D016360:Clostridioides difficile / Q000302:isolation & purification* / Q000472:pathogenicity / Q000502:physiology; D003140:Communicable Disease Control / Q000379:methods*; D017714:Community-Acquired Infections; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*; D005260:Female; D006761:Hospitals; D006801:Humans; D015994:Incidence; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015995:Prevalence; D014481:United States / Q000453:epidemiology
keywords: Clostridium difficile; asymptomatic infections; bacteria; community-acquired infections; healthcare settings; hospital infections; nosocomial infections; theoretical models; transmission