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

Autor:	Crobach MJT; Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: m.j.t.crobach@lumc.nl., Hornung BVH; Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands., Verduin C; Department of Medical Microbiology, Amphia Hospital Breda, the Netherlands., Vos MC; Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, the Netherlands., Hopman J; Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands., Kumar N; Host-Microbiota Interactions Laboratory, Wellcome Sanger Institute, Hinxton, United Kingdom., Harmanus C; Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands., Sanders I; Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands., Terveer EM; Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands., Stares MD; Host-Microbiota Interactions Laboratory, Wellcome Sanger Institute, Hinxton, United Kingdom., Lawley TD; Host-Microbiota Interactions Laboratory, Wellcome Sanger Institute, Hinxton, United Kingdom., Kuijper EJ; 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.
Jazyk:	angličtina
Zdroj:	Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases [Clin Microbiol Infect] 2023 Jul; Vol. 29 (7), pp. 891-896. Date of Electronic Publication: 2023 Mar 05.
DOI:	10.1016/j.cmi.2023.02.022
Abstrakt:	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. Competing Interests: Transparency declaration The authors declare that they have no conflicts of interest. This work was supported by the Netherlands Organisation for Health Research and Development, ZonMW (grant 50-52200-98-035) and Wellcome Sanger core funding (WT098051). (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze:	MEDLINE
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