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2371. A Multicenter Cohort Study of the Natural History of Clostridioides difficile Colonization and Infection

BACKGROUND: Asymptomatic carriage of toxigenic Clostridioides difficile strains is common in healthcare settings. However, the natural history of C. difficile colonization and infection is not well understood, particularly for patients with new acquisition of carriage. METHODS: In 3 tertiary care ho...

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Autores principales: Curry, Scott R, Hecker, Michelle, O’Hagan, Justin, Kutty, Preeta K, Alhmidi, Heba, Karen Ng Wong, Y, Cadnum, Jennifer, Jencson, Annette, Gonzalez-Orta, Melany, Saldana, Carlos S, Wilson, Brigid, Donskey, Curtis
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6809917/
http://dx.doi.org/10.1093/ofid/ofz360.2049
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author Curry, Scott R
Hecker, Michelle
O’Hagan, Justin
Kutty, Preeta K
Alhmidi, Heba
Karen Ng Wong, Y
Cadnum, Jennifer
Jencson, Annette
Gonzalez-Orta, Melany
Saldana, Carlos S
Wilson, Brigid
Donskey, Curtis
author_facet Curry, Scott R
Hecker, Michelle
O’Hagan, Justin
Kutty, Preeta K
Alhmidi, Heba
Karen Ng Wong, Y
Cadnum, Jennifer
Jencson, Annette
Gonzalez-Orta, Melany
Saldana, Carlos S
Wilson, Brigid
Donskey, Curtis
author_sort Curry, Scott R
collection PubMed
description BACKGROUND: Asymptomatic carriage of toxigenic Clostridioides difficile strains is common in healthcare settings. However, the natural history of C. difficile colonization and infection is not well understood, particularly for patients with new acquisition of carriage. METHODS: In 3 tertiary care hospitals and affiliated long-term care facilities (LTCFs), we conducted a 6-month cohort study to identify patients with new acquisition of rectal carriage of toxigenic C. difficile and determined the duration and burden of carriage. Asymptomatic carriage was defined as transient if only 1 culture was positive with negative cultures before and after or persistent if 2 or more cultures were positive; clearance was defined as 2 consecutive negative rectal cultures. RESULTS: Of 4180 patients with negative initial cultures, 144 (3%) acquired asymptomatic carriage of toxigenic C. difficile, and 19 (13%) of these carriers subsequently were diagnosed with CDI. Of 50 asymptomatic carriers analyzed for duration of carriage, 33 (66%) had transient carriage of toxigenic C. difficile and 17 (34%) had persistent carriage. For persistent carriers, the estimated median time to clearance of colonization was 76 days (range, 41 to 95 days from acquisition). Ten of 17 (59%) persistent carriers had a high burden of carriage (defined as > 25 colonies recovered from 1 or more swabs) vs. only 1 of 33 (3%) transient carriers (P < 0.001). CONCLUSION: Acquisition of asymptomatic carriage of toxigenic C. difficile carriage was common among patients in healthcare facilities, but most carriers had transient low-level carriage. Additional studies are needed to determine whether a higher burden of carriage predicts subsequent risk of transmission. DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-68099172019-10-28 2371. A Multicenter Cohort Study of the Natural History of Clostridioides difficile Colonization and Infection Curry, Scott R Hecker, Michelle O’Hagan, Justin Kutty, Preeta K Alhmidi, Heba Karen Ng Wong, Y Cadnum, Jennifer Jencson, Annette Gonzalez-Orta, Melany Saldana, Carlos S Wilson, Brigid Donskey, Curtis Open Forum Infect Dis Abstracts BACKGROUND: Asymptomatic carriage of toxigenic Clostridioides difficile strains is common in healthcare settings. However, the natural history of C. difficile colonization and infection is not well understood, particularly for patients with new acquisition of carriage. METHODS: In 3 tertiary care hospitals and affiliated long-term care facilities (LTCFs), we conducted a 6-month cohort study to identify patients with new acquisition of rectal carriage of toxigenic C. difficile and determined the duration and burden of carriage. Asymptomatic carriage was defined as transient if only 1 culture was positive with negative cultures before and after or persistent if 2 or more cultures were positive; clearance was defined as 2 consecutive negative rectal cultures. RESULTS: Of 4180 patients with negative initial cultures, 144 (3%) acquired asymptomatic carriage of toxigenic C. difficile, and 19 (13%) of these carriers subsequently were diagnosed with CDI. Of 50 asymptomatic carriers analyzed for duration of carriage, 33 (66%) had transient carriage of toxigenic C. difficile and 17 (34%) had persistent carriage. For persistent carriers, the estimated median time to clearance of colonization was 76 days (range, 41 to 95 days from acquisition). Ten of 17 (59%) persistent carriers had a high burden of carriage (defined as > 25 colonies recovered from 1 or more swabs) vs. only 1 of 33 (3%) transient carriers (P < 0.001). CONCLUSION: Acquisition of asymptomatic carriage of toxigenic C. difficile carriage was common among patients in healthcare facilities, but most carriers had transient low-level carriage. Additional studies are needed to determine whether a higher burden of carriage predicts subsequent risk of transmission. DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2019-10-23 /pmc/articles/PMC6809917/ http://dx.doi.org/10.1093/ofid/ofz360.2049 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Curry, Scott R
Hecker, Michelle
O’Hagan, Justin
Kutty, Preeta K
Alhmidi, Heba
Karen Ng Wong, Y
Cadnum, Jennifer
Jencson, Annette
Gonzalez-Orta, Melany
Saldana, Carlos S
Wilson, Brigid
Donskey, Curtis
2371. A Multicenter Cohort Study of the Natural History of Clostridioides difficile Colonization and Infection
title 2371. A Multicenter Cohort Study of the Natural History of Clostridioides difficile Colonization and Infection
title_full 2371. A Multicenter Cohort Study of the Natural History of Clostridioides difficile Colonization and Infection
title_fullStr 2371. A Multicenter Cohort Study of the Natural History of Clostridioides difficile Colonization and Infection
title_full_unstemmed 2371. A Multicenter Cohort Study of the Natural History of Clostridioides difficile Colonization and Infection
title_short 2371. A Multicenter Cohort Study of the Natural History of Clostridioides difficile Colonization and Infection
title_sort 2371. a multicenter cohort study of the natural history of clostridioides difficile colonization and infection
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6809917/
http://dx.doi.org/10.1093/ofid/ofz360.2049
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