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Prevalence and risk factors of toxigenic Clostridioides difficile asymptomatic carriage in 11 French hospitals

Clostridioides difficile infection (CDI) incidence has increased over the last 20 years. Studies suggest that asymptomatic carriers may be an important reservoir of C. difficile in healthcare settings. We conducted a point prevalence study to estimate the toxigenic C. difficile asymptomatic carriage...

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Autores principales: Jolivet, Sarah, Couturier, Jeanne, Grohs, Patrick, Vilfaillot, Aurélie, Zahar, Jean-Ralph, Frange, Pierre, Casetta, Anne, Moulin, Véronique, Lawrence, Christine, Baune, Patricia, Bourgeois, Cléo, Bouffier, Axel, Laussucq, Claudine, Sienzonit, Lydia, Picard, Simon, Podglajen, Isabelle, Kassis-Chikhani, Najiby, Barbut, Frédéric
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10402895/
https://www.ncbi.nlm.nih.gov/pubmed/37547619
http://dx.doi.org/10.3389/fmed.2023.1221363
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author Jolivet, Sarah
Couturier, Jeanne
Grohs, Patrick
Vilfaillot, Aurélie
Zahar, Jean-Ralph
Frange, Pierre
Casetta, Anne
Moulin, Véronique
Lawrence, Christine
Baune, Patricia
Bourgeois, Cléo
Bouffier, Axel
Laussucq, Claudine
Sienzonit, Lydia
Picard, Simon
Podglajen, Isabelle
Kassis-Chikhani, Najiby
Barbut, Frédéric
author_facet Jolivet, Sarah
Couturier, Jeanne
Grohs, Patrick
Vilfaillot, Aurélie
Zahar, Jean-Ralph
Frange, Pierre
Casetta, Anne
Moulin, Véronique
Lawrence, Christine
Baune, Patricia
Bourgeois, Cléo
Bouffier, Axel
Laussucq, Claudine
Sienzonit, Lydia
Picard, Simon
Podglajen, Isabelle
Kassis-Chikhani, Najiby
Barbut, Frédéric
author_sort Jolivet, Sarah
collection PubMed
description Clostridioides difficile infection (CDI) incidence has increased over the last 20 years. Studies suggest that asymptomatic carriers may be an important reservoir of C. difficile in healthcare settings. We conducted a point prevalence study to estimate the toxigenic C. difficile asymptomatic carriage rate and the associated risk factors in patients >3 years old. Between September 16, 2019 and January 15, 2020, all patients hospitalized in 11 healthcare facilities in the Paris urban area were included in the study. They were screened on the day of the survey for toxigenic C. difficile carriage by rectal swab and interviewed. Isolates were characterized by PCR ribotyping and multiplex PCR targeting toxin genes. A logistic regression model was used to determine the risk factors associated with toxigenic C. difficile asymptomatic carriage using uni- and multivariate analysis in the subpopulation of patients >3 years old. During the study period, 2,389 patients were included and screened. The median age was 62 years (interquartile range 35–78 years) and 1,153 were male (48.3%). Nineteen patients had a previous CDI (0.9%). Overall, 185/2389 patients were positive for C. difficile (7.7%), including 93 toxigenic strains (3.9%): 77 (82.8%) were asymptomatic (prevalence 3.2%) whereas 12 (12.9%) were diarrheic. Prevalences of toxigenic C. difficile were 3.5% in patients >3 years old and 7.0% in ≤3 years old subjects, respectively. Toxigenic strains mainly belonged to PCR ribotypes 106 (n = 14, 15.0%), 014 (n = 12, 12.9%), and 020 (n = 10, 10.8%). Among toxigenic strains, 6 (6.4%) produced the binary toxin. In multivariate analysis, two factors were positively associated with toxigenic C. difficile asymptomatic carriage in patients >3 years old: multidrug-resistant organisms co-carriage [adjusted Odd Ratio (aOR) 2.3, CI 95% 1.2–4.7, p = 0.02] and previous CDI (aOR 5.8, CI 95% 1.2–28.6, p = 0.03). Conversely, consumption of raw milk products were associated with reduced risk of toxigenic C. difficile colonization (aOR 0.5, CI 95% 0.2–0.9, p = 0.01). We showed that there was a low prevalence of asymptomatic toxigenic C. difficile carriage in hospitalized patients. Consumption of raw milk prevents toxigenic C. difficile colonization, probably due to the barrier effect of milk-associated bacteria.
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spelling pubmed-104028952023-08-05 Prevalence and risk factors of toxigenic Clostridioides difficile asymptomatic carriage in 11 French hospitals Jolivet, Sarah Couturier, Jeanne Grohs, Patrick Vilfaillot, Aurélie Zahar, Jean-Ralph Frange, Pierre Casetta, Anne Moulin, Véronique Lawrence, Christine Baune, Patricia Bourgeois, Cléo Bouffier, Axel Laussucq, Claudine Sienzonit, Lydia Picard, Simon Podglajen, Isabelle Kassis-Chikhani, Najiby Barbut, Frédéric Front Med (Lausanne) Medicine Clostridioides difficile infection (CDI) incidence has increased over the last 20 years. Studies suggest that asymptomatic carriers may be an important reservoir of C. difficile in healthcare settings. We conducted a point prevalence study to estimate the toxigenic C. difficile asymptomatic carriage rate and the associated risk factors in patients >3 years old. Between September 16, 2019 and January 15, 2020, all patients hospitalized in 11 healthcare facilities in the Paris urban area were included in the study. They were screened on the day of the survey for toxigenic C. difficile carriage by rectal swab and interviewed. Isolates were characterized by PCR ribotyping and multiplex PCR targeting toxin genes. A logistic regression model was used to determine the risk factors associated with toxigenic C. difficile asymptomatic carriage using uni- and multivariate analysis in the subpopulation of patients >3 years old. During the study period, 2,389 patients were included and screened. The median age was 62 years (interquartile range 35–78 years) and 1,153 were male (48.3%). Nineteen patients had a previous CDI (0.9%). Overall, 185/2389 patients were positive for C. difficile (7.7%), including 93 toxigenic strains (3.9%): 77 (82.8%) were asymptomatic (prevalence 3.2%) whereas 12 (12.9%) were diarrheic. Prevalences of toxigenic C. difficile were 3.5% in patients >3 years old and 7.0% in ≤3 years old subjects, respectively. Toxigenic strains mainly belonged to PCR ribotypes 106 (n = 14, 15.0%), 014 (n = 12, 12.9%), and 020 (n = 10, 10.8%). Among toxigenic strains, 6 (6.4%) produced the binary toxin. In multivariate analysis, two factors were positively associated with toxigenic C. difficile asymptomatic carriage in patients >3 years old: multidrug-resistant organisms co-carriage [adjusted Odd Ratio (aOR) 2.3, CI 95% 1.2–4.7, p = 0.02] and previous CDI (aOR 5.8, CI 95% 1.2–28.6, p = 0.03). Conversely, consumption of raw milk products were associated with reduced risk of toxigenic C. difficile colonization (aOR 0.5, CI 95% 0.2–0.9, p = 0.01). We showed that there was a low prevalence of asymptomatic toxigenic C. difficile carriage in hospitalized patients. Consumption of raw milk prevents toxigenic C. difficile colonization, probably due to the barrier effect of milk-associated bacteria. Frontiers Media S.A. 2023-07-19 /pmc/articles/PMC10402895/ /pubmed/37547619 http://dx.doi.org/10.3389/fmed.2023.1221363 Text en Copyright © 2023 Jolivet, Couturier, Grohs, Vilfaillot, Zahar, Frange, Casetta, Moulin, Lawrence, Baune, Bourgeois, Bouffier, Laussucq, Sienzonit, Picard, Podglajen, Kassis-Chikhani and Barbut. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Medicine
Jolivet, Sarah
Couturier, Jeanne
Grohs, Patrick
Vilfaillot, Aurélie
Zahar, Jean-Ralph
Frange, Pierre
Casetta, Anne
Moulin, Véronique
Lawrence, Christine
Baune, Patricia
Bourgeois, Cléo
Bouffier, Axel
Laussucq, Claudine
Sienzonit, Lydia
Picard, Simon
Podglajen, Isabelle
Kassis-Chikhani, Najiby
Barbut, Frédéric
Prevalence and risk factors of toxigenic Clostridioides difficile asymptomatic carriage in 11 French hospitals
title Prevalence and risk factors of toxigenic Clostridioides difficile asymptomatic carriage in 11 French hospitals
title_full Prevalence and risk factors of toxigenic Clostridioides difficile asymptomatic carriage in 11 French hospitals
title_fullStr Prevalence and risk factors of toxigenic Clostridioides difficile asymptomatic carriage in 11 French hospitals
title_full_unstemmed Prevalence and risk factors of toxigenic Clostridioides difficile asymptomatic carriage in 11 French hospitals
title_short Prevalence and risk factors of toxigenic Clostridioides difficile asymptomatic carriage in 11 French hospitals
title_sort prevalence and risk factors of toxigenic clostridioides difficile asymptomatic carriage in 11 french hospitals
topic Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10402895/
https://www.ncbi.nlm.nih.gov/pubmed/37547619
http://dx.doi.org/10.3389/fmed.2023.1221363
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