Program Schedule

Frequent Transmission of Clostridium Difficile by Asymptomatically Colonized Long-term Care Facility Residents during Hospital Admissions

Session: Oral Abstract Session: Clostridium difficile: Epidemiology, Risk Factors, and Impact
Thursday, October 9, 2014: 3:15 PM
Room: The Pennsylvania Convention Center: 109-AB
Background: Colonized long-term care facility (LTCF) residents are a potential source of transmission of healthcare-associated pathogens during hospital admissions. Although asymptomatic carriage of toxin-producing strains of Clostridium difficile is common in LTCFs, it is not known if asymptomatic carriers contribute significantly to transmission in hospitals. 

Methods: During a 6-month period, C. difficile isolates from C. difficile infection (CDI) cases in a VA hospital and from 38 asymptomatic carriers identified through active surveillance in the affiliated LTCF were typed by restriction endonuclease analysis (REA). Ward exposures were defined as the presence of an incident CDI case on the ward concurrently with or within 30 days after discharge of another incident case or an asymptomatic carrier. Linkage was defined as both exposure and an identical REA group or type. Asymptomatic carriers were deemed as shedders if they had a relatively high burden of C. difficile (defined as >26 colonies/perirectal swab) and positive skin and/or environmental cultures.   

Results: Of 25 hospital-onset CDI cases, 9 (36%) were linked to asymptomatic carriers, 10 (40%) were linked to other CDI cases, and 3 (12%) had concurrent exposure to carriers and to other CDI cases. Of the 38 carriers, 24 (63%) had skin and/or environmental shedding and 20 (53%) were transferred to the hospital one or more times (range, 1 to 6 transfers). All potential transmissions from asymptomatic carriers were linked to 5 shedders, including one carrier who was linked to 4 CDI cases during 3 hospital admissions. The most common strains transmitted by carriers were the BI epidemic strain and DQ, a novel binary toxin-positive strain.

Conclusion: LTCF residents asymptomatically colonized with C. difficile may contribute significantly to transmission during hospital admissions. A subset of carriers with increased burden of C. difficile and shedding of spores onto skin and/or into the environment may present a particularly high risk for transmission.

Curtis J. Donskey, MD1,2,3, Venkata C.K. Sunkesula, M.D., M.S1,3, Nimalie D. Stone, MD, MS4, Carolyn V. Gould, MD, MS5, L. Clifford Mcdonald, MD, FACP, FSHEA4, Matthew Samore, MD6, Jeanmarie Mayer, MD7, Susan M. Pacheco, MD8, Annette Jencson, BSMT(ASCP)SM, CIC3, Susan Sambol, MT8, Laurica a. Petrella, BS8 and Dale Gerding, MD9, (1)Case Western Reserve University, Cleveland, OH, (2)Infectious Diseases, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, (3)Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, (4)Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Healthcare Quality Promotion, Atlanta, GA, (5)Centers for Disease Control and Prevention, Atlanta, GA, (6)University of Utah School of Medicine, Division of Epidemiology, Salt Lake City, UT, (7)University of Utah School of Medicine, Salt Lake City, UT, (8)Edward Hines, Jr. Veterans Affairs Hospital, Hines, IL, (9)Loyola University and Hines VA Hospital, Hines, IL


C. J. Donskey, None

V. C. K. Sunkesula, None

N. D. Stone, None

C. V. Gould, None

L. C. Mcdonald, None

M. Samore, None

J. Mayer, None

S. M. Pacheco, CDC : Investigator on another investigators grant, Research support

A. Jencson, None

S. Sambol, None

L. A. Petrella, None

D. Gerding, Sanofi Pasteur: Board Member, Consulting fee
Actellion: Board Member, Consulting fee
Merck: Board Member, Consulting fee
Rebiotix: Board Member, Consulting fee
Viropharma: Consultant, Consulting fee
Summit: Consultant, Consulting fee
Viropharma: patent holder, patent

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