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

Clinical Microbiology and Infection, vol. 29, pp. 891–896

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.

Authors 12

1. Monique J. T. Crobach corresponding Aachen Department of Medical Microbiology

   Leiden University Medical Center

   Affiliation as printed

   Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: m.j.t.crobach@lumc.nl

   Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands

2. Bastian Volker Helmut Hornung Aachen Department of Medical Microbiology

   Leiden University Medical Center

   Affiliation as printed

   Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands

3. Cees M. Verduin

   Amphia Ziekenhuis

   Affiliation as printed

   Department of Medical Microbiology, Amphia Hospital Breda, the Netherlands

4. Martine De Vos

   Erasmus MC

   Affiliation as printed

   Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, the Netherlands

5. Joost Hopman

   Radboud University Medical Center

   Affiliation as printed

   Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands

6. Nitin Kumar

   Wellcome Sanger Institute

   Affiliation as printed

   Host-Microbiota Interactions Laboratory, Wellcome Sanger Institute, Hinxton, United Kingdom

7. Céline Harmanus Aachen Department of Medical Microbiology

   Leiden University Medical Center

   Affiliation as printed

   Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands

8. Ingrid M. J. G. Sanders Aachen Department of Medical Microbiology

   Leiden University Medical Center

   Affiliation as printed

   Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands

9. Elisabeth M. Terveer Aachen Department of Medical Microbiology

   Leiden University Medical Center

   Affiliation as printed

   Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands

10. Mark D. Stares

    Wellcome Sanger Institute

    Affiliation as printed

    Host-Microbiota Interactions Laboratory, Wellcome Sanger Institute, Hinxton, United Kingdom

11. Trevor D. Lawley

    Wellcome Sanger Institute

    Affiliation as printed

    Host-Microbiota Interactions Laboratory, Wellcome Sanger Institute, Hinxton, United Kingdom

12. Ed J. Kuijper Aachen Department of Medical Microbiology

    Leiden University Medical Center · National Institute for Public Health and the Environment

    Affiliation as printed

    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

    Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands

    Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands