Comparison of Clostridium difficile Ribotypes Circulating in Australian Hospitals and Communities.
Clostridium difficile infection (CDI) is becoming less exclusively a health care-associated CDI (HA-CDI). The incidence of community-associated CDI (CA-CDI) has increased over the past few decades. It has been postulated that asymptomatic toxigenic C. difficile (TCD)-colonized patients may play a role in the transfer of C. difficile between the hospital setting and the community. Thus, to investigate the relatedness of C. difficile across the hospital and community settings, we compared the characteristics of symptomatic and asymptomatic host patients and the pathogens from these patients in these two settings over a 3-year period. Two studies were simultaneously conducted; the first study enrolled symptomatic CDI patients from two tertiary care hospitals and the community in two Australian states, while the second study enrolled asymptomatic TCD-colonized patients from the same tertiary care hospitals. A total of 324 patients (96 with HA-CDI, 152 with CA-CDI, and 76 colonized with TCD) were enrolled. The predominant C. difficile ribotypes isolated in the hospital setting corresponded with those isolated in the community, as it was found that for 79% of the C. difficile isolates from hospitals, an isolate with a matching ribotype was isolated in the community, suggesting that transmission between these two settings is occurring. The toxigenic C. difficile strains causing symptomatic infection were similar to those causing asymptomatic infection, and patients exposed to antimicrobials prior to admission were more likely to develop a symptomatic infection (odds ratio, 2.94; 95% confidence interval, 1.20 to 7.14). Our findings suggest that the development of CDI symptoms in a setting without establishment of hospital epidemics with binary toxin-producing C. difficile strains may be driven mainly by host susceptibility and exposure to antimicrobials, rather than by C. difficile strain characteristics.
Research School of Population Health, The Australian National University, Canberra, ACT, Australia.
Luis
L
Furuya-Kanamori
Microbiology & Immunology, School of Pathology & Laboratory Medicine, The University of Western Australia, Nedlands, WA, Australia.|Department of Microbiology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, WA, Australia.
Thomas V
TV
Riley
UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia.
David L
DL
Paterson
Microbiology & Immunology, School of Pathology & Laboratory Medicine, The University of Western Australia, Nedlands, WA, Australia.|Department of Microbiology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, WA, Australia.
Niki F
NF
Foster
UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia.
Charlotte A
CA
Huber
Microbiology & Immunology, School of Pathology & Laboratory Medicine, The University of Western Australia, Nedlands, WA, Australia.
Stacey
S
Hong
UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia.
Tiffany
T
Harris-Brown
Sullivan Nicolaides Pathology, Taringa, QLD, Australia.
Jenny
J
Robson
Research School of Population Health, The Australian National University, Canberra, ACT, Australia director.rsph@anu.edu.au.
Archie C A
AC
Clements
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D002353:Carrier State / Q000453:epidemiology / Q000382:microbiology; D016360:Clostridioides difficile / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification; D003015:Clostridium Infections / Q000453:epidemiology / Q000382:microbiology*; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology*; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology*; D016021:Epidemiologic Studies; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D021521:Ribotyping; D055815:Young Adult
Clostridium difficile; asymptomatic; community-acquired infections; health care-acquired infection; ribotyping