Impact of ToxigenicClostridium difficileColonization on the Risk of SubsequentC. difficileInfection in Intensive Care Unit Patients

Abstract

BACKGROUNDClostridium difficileinfection (CDI) in hospitalized patients is generally attributed to the current stay, but recent studies reveal highC. difficilecolonization rates on admission.OBJECTIVETo determine the rate of colonization with toxigenicC. difficileamong intensive care unit patients upon admission as well as acquired during hospitalization, and the risk of subsequent CDI.METHODSProspective cohort study from April 15 through July 8, 2013. Adults admitted to an intensive care unit within 48 hours of admission to the Johns Hopkins Hospital, Baltimore, Maryland, were screened for colonization with toxigenicC. difficile. The primary outcome was risk of developing CDI.RESULTSAmong 542 patients, 17 (3.1%) were colonized with toxigenicC. difficileon admission and an additional 3 patients were found to be colonized during hospitalization. Both colonization with toxigenicC. difficileon admission and colonization during hospitalization were associated with an increased risk for development of CDI (relative risk, 10.29 [95% CI, 2.24–47.40],P=.003; and 15.66 [4.01–61.08],P<.001, respectively). Using multivariable analysis, colonization on admission and colonization during hospitalization were independent predictors of CDI (relative risk, 8.62 [95% CI, 1.48–50.25],P=.017; and 10.93 [1.49–80.20],P=.019, respectively), while adjusting for potential confounders.CONCLUSIONSIn intensive care unit patients, colonization with toxigenicC. difficileis an independent risk factor for development of subsequent CDI. Further studies are needed to identify populations with higher toxigenicC. difficilecolonization rates possibly benefiting from screening or avoidance of agents known to promote CDI.Infect. Control Hosp. Epidemiol.2015;36(11):1324–1329