Journal Article

Asymptomatic Carriers Are a Potential Source for Transmission of Epidemic and Nonepidemic <i>Clostridium difficile</i> Strains among Long-Term Care Facility Residents

Michelle M. Riggs, Ajay K. Sethi, Trina F. Zabarsky, Elizabeth C. Eckstein, Robin L. P. Jump and Curtis J. Donskey

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 45, issue 8, pages 992-998
Published in print October 2007 | ISSN: 1058-4838
Published online October 2007 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/521854
Asymptomatic Carriers Are a Potential Source for Transmission of Epidemic and Nonepidemic Clostridium difficile Strains among Long-Term Care Facility Residents

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Background. Asymptomatic fecal carriage of Clostridium difficile is common in patients staying in health care facilities, but the importance of asymptomatic carriers with regard to disease transmission is unclear.

Methods. We prospectively examined the prevalence of asymptomatic carriage of epidemic North American pulsed-field gel electrophoresis type 1 and nonepidemic toxigenic C. difficile strains among long-term care patients in the context of an outbreak of C. difficile–associated disease and evaluated the frequency of skin and environmental contamination. Molecular typing was performed by pulsed-field gel electrophoresis. Logistic regression was used to assess factors associated with asymptomatic carriage, and a sensitive and specific prediction rule was developed to identify high-risk patients.

Results. Thirty-five (51%) of 68 asymptomatic patients were carriers of toxigenic C. difficile, and 13 (37%) of these patients carried epidemic strains. Compared with noncarriers, asymptomatic carriers had higher percentages of skin (61% vs. 19%; P = .001) and environmental contamination (59% vs. 24%; P = .004). Eighty-seven percent of isolates found in skin samples and 58% of isolates found in environmental samples were identical to concurrent isolates found in stool samples. Spores on the skin of asymptomatic patients were easily transferred to investigators' hands. Previous C. difficile–associated disease (P < .001) and previous antibiotic use (P = .017) were associated with asymptomatic carriage, and the combination of these 2 variables was predictive of asymptomatic carriage (sensitivity, 77%; specificity, 58%; positive predictive value, 66%; negative predictive value, 70%).

Conclusions. Our findings suggest that asymptomatic carriers of epidemic and nonepidemic C. difficile strains have the potential to contribute significantly to disease transmission in long-term care facilities. Clinical factors, such as previous C. difficile–associated disease and recent antibiotic use, may be predictive of asymptomatic carriage.

Journal Article.  4245 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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