Screening for Clostridioides difficile colonization at admission to the hospital: a multi-centre study

Monique J T Crobach; Bastian V H Hornung; Cees Verduin; Margreet C Vos; Joost Hopman; Nitin Kumar; Celine Harmanus; Ingrid Sanders; Elisabeth M Terveer; Mark D Stares; Trevor D Lawley; Ed J Kuijper

doi:10.1016/j.cmi.2023.02.022

Screening for Clostridioides difficile colonization at admission to the hospital: a multi-centre study

Clin Microbiol Infect. 2023 Jul;29(7):891-896. doi: 10.1016/j.cmi.2023.02.022. Epub 2023 Mar 5.

Authors

Affiliations

¹ Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: m.j.t.crobach@lumc.nl.
² Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands.
³ Department of Medical Microbiology, Amphia Hospital Breda, the Netherlands.
⁴ Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, the Netherlands.
⁵ Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands.
⁶ Host-Microbiota Interactions Laboratory, Wellcome Sanger Institute, Hinxton, United Kingdom.
⁷ Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands; Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.

PMID: 36871826
DOI: 10.1016/j.cmi.2023.02.022

Abstract

Objectives: To assess the value of screening for Clostridioides difficile colonization (CDC) at hospital admission in an endemic setting.

Methods: A multi-centre study was conducted at four hospitals located across the Netherlands. Newly admitted patients were screened for CDC. The risk of development of Clostridioides difficile infection (CDI) during admission and 1-year follow-up was assessed in patients with and without colonization. C. difficile isolates from patients with colonization were compared with isolates from incident CDI cases using core genome multi-locus sequence typing to determine whether onwards transmission had occurred.

Results: CDC was present in 108 of 2211 admissions (4.9%), whereas colonization with a toxigenic strain (toxigenic Clostridoides difficile colonization [tCDC]) was present in 68 of 2211 admissions (3.1%). Among these 108 patients with colonization, diverse PCR ribotypes were found and no 'hypervirulent' PCR ribotype 027 (RT027) was detected (95% CI, 0-0.028). None of the patients with colonization developed CDI during admission (0/49; 95% CI, 0-0.073) or 1-year follow-up (0/38; 95% CI, 0-0.93). Core genome multi-locus sequence typing identified six clusters with genetically related isolates from patients with tCDC and CDI; however, in these clusters, only one possible transmission event from a patient with tCDC to a patient with CDI was identified based on epidemiological data.

Conclusion: In this endemic setting with a low prevalence of 'hypervirulent' strains, screening for CDC at admission did not detect any patients with CDC who progressed to symptomatic CDI and detected only one possible transmission event from a patient with colonization to a patient with CDI. Thus, screening for CDC at admission is not useful in this setting.

Keywords: Clostridioides difficile; Colonization; Healthcare associated infections; Infection prevention; Transmission analysis.

Publication types

Multicenter Study

MeSH terms

Clostridioides / genetics
Clostridioides difficile* / genetics
Clostridium Infections* / diagnosis
Clostridium Infections* / epidemiology
Clostridium Infections* / microbiology
Hospitalization
Hospitals
Humans
Multilocus Sequence Typing
Ribotyping