428. Asymptomatic Clostridium Difficile Colonization among Hospitalized Patients at a Tertiary Care Center
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Most cases of C. difficile infection (CDI) result from nosocomial acquisition. Patients asymptomatically colonized with C. difficile (CD) may serve as unrecognized reservoirs contributing to nosocomial transmission. The aim of this study was to determine the prevalence of, and risk factors for, asymptomatic colonization with toxigenic CD at admission to a tertiary care hospital.
Methods: All adults admitted to St. Mary’s Hospital (Rochester, MN) in a defined period (2-3 days/week, March-April 2009) were eligible. The first stool specimen available after admission was requested from each consenting patient and tested for toxigenic CD using a previously validated PCR assay that detects tcdC. Clinical data were obtained through patient interviews and record reviews.
Results: After excluding those who were dismissed in < 24 hrs (263), unable to consent (264), refused (177), had known CDI or symptoms of colitis (36), 724 (50%) patients consented. Stool samples were received from 319 (22%) patients within 5 days of admission. Of these, 29 (9%) tested positive for toxigenic CD by PCR. In univariate analysis, hospitalization in the previous 3 months, chronic dialysis, proton pump inhibitor use, and recent steroid use were associated with CD colonization (all chi-square P < 0.05), whereas nursing home residence, frequent outpatient care, previous CDI, recent antibiotic use, and immunosuppression other than steroids were not. In multivariable logistic regression analysis, any healthcare contact in the previous 3 months was independently associated with CD colonization (odds ratio 3.8, 95% CI 1.4-9.7). The overall prevalence of recent healthcare contact (48%) and antibiotic use (64%) was high.
Conclusion: Asymptomatic colonization with toxigenic CD at the time of admission was common (9%) in this hospital-wide study. Previous healthcare contact, particularly recent hospitalization and chronic dialysis, were risk factors for colonization.
Kimberly Aronhalt, MA, BSN, RN1, Surbhi Leekha, MBBS, MPH, Robert Orenstein, DO3, Robin Patel, MD, FIDSA1, Jon Rosenblatt, MD1, Mary Shelerud, RN, BSN1, Martha Siska, RN, BSN1, Lynne Sloan, BS1 and  S. Leekha, None..
K. Aronhalt, None..
M. Shelerud, None..
M. Siska, None..
L. Sloan, None. 
J. Rosenblatt,
Roche Diagnostics Role(s): Other, Received: Licensing Agreement or Royalty.
R. Patel, None..
R. Orenstein, None., (1)Mayo Clinic, Rochester, MN, (2)Division of Infectious diseases, Mayo Clinic, Phoenix, AZ