Screening ofClostridioides difficilecarriers in an urban academic medical center: Understanding implications of disease

Objective:Efforts to reduceClostridioides difficileinfection (CDI) have targeted transmission from patients with symptomaticC. difficile. However, many patients with theC. difficileorganism are carriers without symptoms who may serve as reservoirs for spread of infection and may be at risk for progression to symptomaticC. difficile. To estimate the prevalence ofC. difficilecarriage and determine the risk and speed of progression to symptomaticC. difficileamong carriers, we established a pilot screening program in a large urban hospital.Design:Prospective cohort study.Setting:An 800-bed, tertiary-care, academic medical center in the Bronx, New York.Participants:A sample of admitted adults without diarrhea, with oversampling of nursing facility patients.Methods:Perirectal swabs were tested by polymerase chain reaction forC. difficilewithin 24 hours of admission, and patients were followed for progression to symptomaticC. difficile. Development of symptomaticC. difficilewas compared amongC. difficilecarriers and noncarriers using a Cox proportional hazards model.Results:Of the 220 subjects, 21 (9.6%) wereC. difficilecarriers, including 10.2% of the nursing facility residents and 7.7% of the community residents (P= .60). Among the 21C. difficilecarriers, 8 (38.1%) progressed to symptomaticC. difficile, but only 4 (2.0%) of the 199 noncarriers progressed to symptomaticC. difficile(hazard ratio, 23.9; 95% CI, 7.2–79.6;P< .0001).Conclusions:Asymptomatic carriage ofC. difficileis prevalent among admitted patients and confers a significant risk of progression to symptomatic CDI. Screening for asymptomatic carriers may represent an opportunity to reduce CDI.