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

Crobach, M.J.T.; Hornung, B.V.H.; Verduin, C.; Vos, M.C.; Hopman, J.; Kumar, N.; ... ; Kuijper, E.J. (2023)

Article / Letter to editor

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. Monique J.T. Crobach, Clin Microbiol Infect 2023;29:891 & COPY; 2023 The Authors. Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases. This is an open access article under the CC BY license (http://creativecommons.org/ licenses/by/4.0/).

• Clostridioides dif ficile
• Colonization
• Infection prevention
• Transmission analysis
• Healthcare associated infections

• All authors: Crobach, M.J.T.; Hornung, B.V.H.; Verduin, C.; Vos, M.C.; Hopman, J.; Kumar, N.; Harmanus, C.; Sanders, I.; Terveer, E.M.; Stares, M.D.; Lawley, T.D.; Kuijper, E.J.
• Date: 2023-07-01
• Journal: Clinical Microbiology and Infection
• Volume: 29
• Issue: 7
• Pages: 891 - 896
• DOI: doi:10.1016/j.cmi.2023.02.022