91. Household surveillance of patients with recurrent Clostridium difficile infection (CDI)
Session: Oral Abstract Session: New Considerations in C. difficile Prevention and Treatment
Thursday, October 3, 2013: 9:42 AM
Room: The Moscone Center: 300
Background: Recurrent CDI is common and difficult to treat, leading to the need for fecal microbiota transplantation (FMT). Although Clostridium difficile (CD) spores are known to persist in the hospital environment and lead to infection, little is known about the potential presence and contribution to infection of CD spores in the home environment.

Methods: Households of recurrent CDI patients peri- and post-FMT, and control households containing subjects of similar age and geographical region, were recruited to undergo surveillance, including sampling surfaces within the home (kitchens, bathrooms, high touch areas, and vacuum cleaners), and to provide a fecal sample from all humans and pets in the household. Household members completed a survey regarding their medical history, healthcare exposure, personal hygiene, and household cleaning habits. Environmental and fecal samples were cultured for CD using broth enrichment, and cycloserine-cefoxitin fructose, Mclung toabe, and blood agar plates. The identities of presumptive CD isolates were confirmed using PRO disk, Gram stain, and molecular analyses.

Results: To date, 8 peri-FMT, 8 post-FMT (4 at 6 months and 4 at 2 years post-FMT), and 8 control households have been surveyed. CD was isolated from 3/42 (7%) of fecal samples submitted by case patients, household members, and pets (2 from peri-FMT case patients and 1 from a peri-FMT household member). CD was isolated from ≥ 1 surface in 8 (100%) peri-FMT households, 3 (37.5%) post-FMT households (2 of 4 at 6 months, and 1 of 4 at 2 years), and 3 (37.5%) control households (p = 0.025). Out of 34 positive environmental samples, the most common CD positive surfaces included the vacuum cleaner (11 samples, 33%), toilet (8, 24%), and bathroom sink (5, 15%). Further analysis of CD presence in relation to personal and household characteristics is ongoing, as is molecular analysis of CD isolates.

Conclusion: CD can be found in the household environment of patients with recurrent CDI, especially peri-FMT. Whether this is a cause or consequence of recurrent CDI is unknown. If household contamination contributes to recurrent CDI, effective decontamination may decrease CDI recurrence rates.

Megan K. Shaughnessy, MD1, Aleh Bobr, MD2, Michael Sadowsky, PhD2, Alexander Khoruts, MD3 and James R. Johnson, MD3,4, (1)Infectious Diseases, University of Minnesota, Minneapolis, MN, (2)Biotechnology Institute, Falcon Heights, MN, (3)University of Minnesota, Minneapolis, MN, (4)Minneapolis VA Medical Center, Minneapolis, MN


M. K. Shaughnessy, None

A. Bobr, None

M. Sadowsky, None

A. Khoruts, None

J. R. Johnson, None

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