Asymptomatic Clostridium difficile colonization in two Australian tertiary hospitals, 2012–2014: prospective, repeated cross-sectional study

L. Furuya-Kanamori, A. C A Clements, N. F. Foster, Charlotte A. Huber, S. Hong, Tiffany Harris-Brown, L. Yakob, D. L. Paterson, T. V. Riley

    Research output: Contribution to journalArticle

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    Abstract

    Objectives To investigate the prevalence and risk factors for asymptomatic toxigenic (TCD) and nontoxigenic Clostridium difficile (NTCD) colonization in a broad cross section of the general hospital population over a 3-year period. Methods Patients without diarrhoea admitted to two Australian tertiary hospitals were randomly selected through six repeated cross-sectional surveys conducted between 2012 and 2014. Stool specimens were cultured under anaerobic conditions, and C. difficile isolates were tested for the presence of toxin genes and ribotyped. Patients were then grouped into noncolonized, TCD colonized or NTCD colonized for identifying risk factors using multinomial logistic regression models. Results A total of 1380 asymptomatic patients were enrolled; 76 patients (5.5%) were TCD colonized and 28 (2.0%) were NTCD colonized. There was a decreasing annual trend in TCD colonization, and asymptomatic colonization was more prevalent during the summer than winter months. TCD colonization was associated with gastro-oesophageal reflux disease (relative risk ratio (RRR) = 2.20; 95% confidence interval (CI) 1.17–4.14), higher number of admissions in the previous year (RRR = 1.24; 95% CI 1.10–1.39) and antimicrobial exposure during the current admission (RRR = 2.78; 95% CI 1.23–6.28). NTCD colonization was associated with chronic obstructive pulmonary disease (RRR = 3.88; 95% CI 1.66–9.07) and chronic kidney failure (RRR = 5.78; 95% CI 2.29–14.59). Forty-eight different ribotypes were identified, with 014/020 (n = 23), 018 (n = 10) and 056 (n = 6) being the most commonly isolated. Conclusions Risk factors differ between patients with asymptomatic colonization by toxigenic and nontoxigenic strains. Given that morbidity is largely driven by toxigenic strains, this novel finding has important implications for disease control and prevention.  © 2016 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd.

    Original languageEnglish
    Pages (from-to)48.e1-48.e7
    Number of pages7
    JournalClinical Microbiology and Infection
    Volume23
    Issue number1
    Early online date8 Sep 2016
    DOIs
    Publication statusPublished - 1 Jan 2017

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    Clostridium difficile
    Tertiary Care Centers
    Cross-Sectional Studies
    Odds Ratio
    Confidence Intervals
    Ribotyping
    Logistic Models
    Esophageal Diseases
    Gastroesophageal Reflux
    General Hospitals
    Chronic Obstructive Pulmonary Disease
    Chronic Kidney Failure
    Communicable Diseases
    Diarrhea
    Morbidity
    Population
    Genes

    Cite this

    Furuya-Kanamori, L. ; Clements, A. C A ; Foster, N. F. ; Huber, Charlotte A. ; Hong, S. ; Harris-Brown, Tiffany ; Yakob, L. ; Paterson, D. L. ; Riley, T. V. / Asymptomatic Clostridium difficile colonization in two Australian tertiary hospitals, 2012–2014 : prospective, repeated cross-sectional study. In: Clinical Microbiology and Infection. 2017 ; Vol. 23, No. 1. pp. 48.e1-48.e7.
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    title = "Asymptomatic Clostridium difficile colonization in two Australian tertiary hospitals, 2012–2014: prospective, repeated cross-sectional study",
    abstract = "Objectives To investigate the prevalence and risk factors for asymptomatic toxigenic (TCD) and nontoxigenic Clostridium difficile (NTCD) colonization in a broad cross section of the general hospital population over a 3-year period. Methods Patients without diarrhoea admitted to two Australian tertiary hospitals were randomly selected through six repeated cross-sectional surveys conducted between 2012 and 2014. Stool specimens were cultured under anaerobic conditions, and C. difficile isolates were tested for the presence of toxin genes and ribotyped. Patients were then grouped into noncolonized, TCD colonized or NTCD colonized for identifying risk factors using multinomial logistic regression models. Results A total of 1380 asymptomatic patients were enrolled; 76 patients (5.5{\%}) were TCD colonized and 28 (2.0{\%}) were NTCD colonized. There was a decreasing annual trend in TCD colonization, and asymptomatic colonization was more prevalent during the summer than winter months. TCD colonization was associated with gastro-oesophageal reflux disease (relative risk ratio (RRR) = 2.20; 95{\%} confidence interval (CI) 1.17–4.14), higher number of admissions in the previous year (RRR = 1.24; 95{\%} CI 1.10–1.39) and antimicrobial exposure during the current admission (RRR = 2.78; 95{\%} CI 1.23–6.28). NTCD colonization was associated with chronic obstructive pulmonary disease (RRR = 3.88; 95{\%} CI 1.66–9.07) and chronic kidney failure (RRR = 5.78; 95{\%} CI 2.29–14.59). Forty-eight different ribotypes were identified, with 014/020 (n = 23), 018 (n = 10) and 056 (n = 6) being the most commonly isolated. Conclusions Risk factors differ between patients with asymptomatic colonization by toxigenic and nontoxigenic strains. Given that morbidity is largely driven by toxigenic strains, this novel finding has important implications for disease control and prevention.  {\circledC} 2016 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd.",
    keywords = "Asymptomatic, Clostridium difficile, Colonization, Prevalence, Toxigenic",
    author = "L. Furuya-Kanamori and Clements, {A. C A} and Foster, {N. F.} and Huber, {Charlotte A.} and S. Hong and Tiffany Harris-Brown and L. Yakob and Paterson, {D. L.} and Riley, {T. V.}",
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    Asymptomatic Clostridium difficile colonization in two Australian tertiary hospitals, 2012–2014 : prospective, repeated cross-sectional study. / Furuya-Kanamori, L.; Clements, A. C A; Foster, N. F.; Huber, Charlotte A.; Hong, S.; Harris-Brown, Tiffany; Yakob, L.; Paterson, D. L.; Riley, T. V.

    In: Clinical Microbiology and Infection, Vol. 23, No. 1, 01.01.2017, p. 48.e1-48.e7.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Asymptomatic Clostridium difficile colonization in two Australian tertiary hospitals, 2012–2014

    T2 - prospective, repeated cross-sectional study

    AU - Furuya-Kanamori, L.

    AU - Clements, A. C A

    AU - Foster, N. F.

    AU - Huber, Charlotte A.

    AU - Hong, S.

    AU - Harris-Brown, Tiffany

    AU - Yakob, L.

    AU - Paterson, D. L.

    AU - Riley, T. V.

    PY - 2017/1/1

    Y1 - 2017/1/1

    N2 - Objectives To investigate the prevalence and risk factors for asymptomatic toxigenic (TCD) and nontoxigenic Clostridium difficile (NTCD) colonization in a broad cross section of the general hospital population over a 3-year period. Methods Patients without diarrhoea admitted to two Australian tertiary hospitals were randomly selected through six repeated cross-sectional surveys conducted between 2012 and 2014. Stool specimens were cultured under anaerobic conditions, and C. difficile isolates were tested for the presence of toxin genes and ribotyped. Patients were then grouped into noncolonized, TCD colonized or NTCD colonized for identifying risk factors using multinomial logistic regression models. Results A total of 1380 asymptomatic patients were enrolled; 76 patients (5.5%) were TCD colonized and 28 (2.0%) were NTCD colonized. There was a decreasing annual trend in TCD colonization, and asymptomatic colonization was more prevalent during the summer than winter months. TCD colonization was associated with gastro-oesophageal reflux disease (relative risk ratio (RRR) = 2.20; 95% confidence interval (CI) 1.17–4.14), higher number of admissions in the previous year (RRR = 1.24; 95% CI 1.10–1.39) and antimicrobial exposure during the current admission (RRR = 2.78; 95% CI 1.23–6.28). NTCD colonization was associated with chronic obstructive pulmonary disease (RRR = 3.88; 95% CI 1.66–9.07) and chronic kidney failure (RRR = 5.78; 95% CI 2.29–14.59). Forty-eight different ribotypes were identified, with 014/020 (n = 23), 018 (n = 10) and 056 (n = 6) being the most commonly isolated. Conclusions Risk factors differ between patients with asymptomatic colonization by toxigenic and nontoxigenic strains. Given that morbidity is largely driven by toxigenic strains, this novel finding has important implications for disease control and prevention.  © 2016 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd.

    AB - Objectives To investigate the prevalence and risk factors for asymptomatic toxigenic (TCD) and nontoxigenic Clostridium difficile (NTCD) colonization in a broad cross section of the general hospital population over a 3-year period. Methods Patients without diarrhoea admitted to two Australian tertiary hospitals were randomly selected through six repeated cross-sectional surveys conducted between 2012 and 2014. Stool specimens were cultured under anaerobic conditions, and C. difficile isolates were tested for the presence of toxin genes and ribotyped. Patients were then grouped into noncolonized, TCD colonized or NTCD colonized for identifying risk factors using multinomial logistic regression models. Results A total of 1380 asymptomatic patients were enrolled; 76 patients (5.5%) were TCD colonized and 28 (2.0%) were NTCD colonized. There was a decreasing annual trend in TCD colonization, and asymptomatic colonization was more prevalent during the summer than winter months. TCD colonization was associated with gastro-oesophageal reflux disease (relative risk ratio (RRR) = 2.20; 95% confidence interval (CI) 1.17–4.14), higher number of admissions in the previous year (RRR = 1.24; 95% CI 1.10–1.39) and antimicrobial exposure during the current admission (RRR = 2.78; 95% CI 1.23–6.28). NTCD colonization was associated with chronic obstructive pulmonary disease (RRR = 3.88; 95% CI 1.66–9.07) and chronic kidney failure (RRR = 5.78; 95% CI 2.29–14.59). Forty-eight different ribotypes were identified, with 014/020 (n = 23), 018 (n = 10) and 056 (n = 6) being the most commonly isolated. Conclusions Risk factors differ between patients with asymptomatic colonization by toxigenic and nontoxigenic strains. Given that morbidity is largely driven by toxigenic strains, this novel finding has important implications for disease control and prevention.  © 2016 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd.

    KW - Asymptomatic

    KW - Clostridium difficile

    KW - Colonization

    KW - Prevalence

    KW - Toxigenic

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