{Reference Type}: Comparative Study
{Title}: Environmental shedding of toxigenic Clostridioides difficile by asymptomatic carriers: A prospective observational study.
{Author}: Gilboa M;Houri-Levi E;Cohen C;Tal I;Rubin C;Feld-Simon O;Brom A;Eden-Friedman Y;Segal S;Rahav G;Regev-Yochay G; ;
{Journal}: Clin Microbiol Infect
{Volume}: 26
{Issue}: 8
{Year}: Aug 2020
{Factor}: 13.31
{DOI}: 10.1016/j.cmi.2019.12.011
{Abstract}: <B>OBJECTIVE: </B>The aim was to compare the burden of environmental shedding of toxigenic Clostridioides difficile among asymptomatic carriers, C. difficile-infected (CDI) patients and non-carriers in an inpatient non-epidemic setting.<BR><B>METHODS: </B>C. difficile carriage was determined by positive toxin-B PCR from rectal swabs of asymptomatic patients. Active CDI was defined as a positive two-step enzyme immunoassay/polymerase chain reaction (EIA/PCR) test in patients with more than three unformed stools/24 hr. C. difficile environmental contamination was assessed by obtaining specimens from ten sites in the patients' rooms. Toxigenic strains were identified by PCR. We created a contamination scale to define the overall level of room contamination that ranged from clean to heavy contamination.<BR><B>RESULTS: </B>One hundred and seventeen rooms were screened: 70 rooms inhabited by C. difficile carriers, 30 rooms by active CDI patients and 17 rooms by non C. difficile -carriers (control). In the carrier rooms 29 (41%) had more than residual contamination, from which 17 (24%) were heavily contaminated. In the CDI rooms 12 (40%) had more than residual contamination from which three (10%) were heavily contaminated, while in the control rooms, one room (6%) had more than residual contamination and none were heavily contaminated. In a multivariate analysis, the contamination score of rooms inhabited by carriers did not differ from rooms of CDI patients, yet both were significantly more contaminated than those of non-carriers odd ratio 12.23 and 11.16 (95% confidence interval 1.5-99.96 p 0.0195, and 1.19-104.49 p 0.035), respectively.<BR><B>CONCLUSIONS: </B>Here we show that the rooms of C. difficile carriers are as contaminated as those of patients with active CDI and significantly more than those of non-carriers.