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Study Reveals Low Rates of Asymptomatic Carriers of C difficile in Hospitals

A recent study conducted in France has provided new insights into the risks of C difficile infection (CDI) transmission within healthcare settings. Published in the journal Frontiers in Medicine, the study aimed to better understand how to prevent in-hospital transmission of C difficile and to determine the prevalence of asymptomatic carriers of toxigenic strains.

C difficile is responsible for nearly half of all nosocomial gastrointestinal infections in European hospitals. The incidence of CDI among hospitalized patients in France has been on the rise in the past two decades. This increase has been attributed to the challenges of containing CDI in healthcare settings, particularly due to the presence of asymptomatic carriers.

The study revealed that asymptomatic carriers of toxigenic C difficile strains pose a significant risk of transmission, as their environments were found to be as contaminated as those of symptomatic CDI patients. However, routine screening for asymptomatic carriers is currently not recommended in infection control guidelines.

To determine whether asymptomatic carrier screening should be incorporated into guidelines, the researchers screened patients at 11 hospitals in the Paris area. Between September 2019 and January 2020, a total of 2389 patients who had been hospitalized for more than 24 hours were included in the study. Screening involved testing for toxigenic C difficile and interviewing patients.

The results showed that 7.7% of the patients tested positive for C difficile, with 3.2% being asymptomatic carriers. Out of the positive cases, 82.8% were asymptomatic. These rates were lower than previous reports, which may be due to differences in studied populations and the use of different microbiological techniques for isolation.

The study also revealed some notable findings regarding age and risk factors. Children ages 3 and younger had higher rates of C difficile positivity, aligning with previous studies. Among patients older than age 3, previous CDI and co-carriage of multidrug-resistant organisms were associated with an increased risk of asymptomatic toxigenic carriage of C difficile. On the other hand, patients who consumed raw milk products were less likely to be colonized, possibly due to the barrier effect of milk-associated bacteria.

While the study had limitations, such as non-inclusion and non-screening of eligible patients, as well as the use of less sensitive rectal swabbing instead of stool specimens, it benefited from the inclusion of a large number of patients and hospitals, and an analysis that was not limited to high-risk patients.

The findings of this study emphasize the importance of considering asymptomatic carriers in infection control strategies. It suggests that identifying and isolating C difficile carriers may contribute to a decreased incidence of CDI in healthcare settings. Further research and evaluation are needed to determine the feasibility and effectiveness of routine screening for asymptomatic carriers, as well as the potential impact on infection prevention and patient outcomes.

Source: https://www.contagionlive.com/view/hospitals-finds-low-rates-of-asymptomatic-toxigenic-c-difficile-carriage

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