Tag Archives: Community acquired C diff

Community-acquired C. diff. Infection (CA-CDI)

How is Clostridioides difficile epidemiology changing?


What risk factors are associated with community-acquired C. diff (CA-CDI)?

How has molecular epidemiology improved our understanding of Cdiff transmission?

What are the potential novel sources of Cdiff?

Investigators with Duke University Medical Center certainly asked the right questions in “Novel and Emerging Sources of Clostridioides difficile Infection,” a new study published December 19 in PLOS Pathogens.

The global answer is that infection preventionists and other infection control professionals will have their work cut out for them in the coming year. They’ll have to contend with diversity among C. diff isolates, mounting evidence that it’s often transmitted outside the hospital, and that those multiple sources of infection will put current infection control processes to the test. Coming up with the best approach will take lots of exposure-related data, coupled with whole-genome sequencing.

“With the additional issues of widespread outpatient healthcare contact, asymptomatic carriage, and long-term environmental persistence of spores, even the basic distinction between community- versus healthcare-associated CDI may become less relevant with time,” the study states.

Mathematical modeling studies suggest reducing transmission would require that patients with C. diff be placed in single rooms and the healthcare workers who care for them wear gowns and gloves. Clinical data supporting this method are missing, however. “Molecular epidemiologic studies attribute a relatively small minority of transmission events to carriers,” the study states.

It’s more of a challenge to investigate CA-CDI than healthcare-associated infections (HAIs). There aren’t even that many population-based studies on CDI incidence, say, investigators.

Which population is most at risk?

And how does the healthcare system go about tracking it?

These questions have not been answered and don’t look to be answered anytime soon.

“One of the major issues with defining populations at risk for CA-CDI is a lack of centralized testing or surveillance,” the study states. “Because patients are able to present to urgent care, primary care offices, emergency rooms, and hospitals, often all belonging to different healthcare networks, it is extremely difficult to determine how many cases are occurring within a particular community.”

The fact that most C. diff interventions occur within the hospital also limits what can be done about CA-CDI. It’s also unclear just how the infection travels: from the community into the hospital, the other way around, or some combination of both?

Also, “even though healthcare contact is frequently associated with CA-CDI, it remains unclear if this reflects patients who are actually at elevated risk because of multiple chronic health problems or if contact with healthcare is truly what is driving the risk.”

Nursing homes and long-term care facilities seem to be breeding grounds for C. diff and may be a major source of C. diff infection in hospitals because many of the residents in those latter facilities often wind up in the hospital.

“With the additional issues of widespread outpatient healthcare contact, asymptomatic carriage, and long-term environmental persistence of spores, even the basic distinction between community- versus healthcare-associated CDI may become less relevant with time.

Given the challenges posed by current evidence of interspecies transmission and environmental reservoirs of Cdifficile, future research in C. difficile prevention will require an integrative multidisciplinary approach, as exemplified by the OneHealth concept.”

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C. difficile Infection Study By Yale-led Team Estimate Transmission Rates In Three Healthcare Settings

In The News

A Yale-led study estimates transmission rates inside and outside of hospitals, providing insight into different sources of the infection and how it might be better controlled.

Previous studies found that less than half of C. diff infections in hospitalized patients could be attributed to spread from other infected patients. “It’s traditionally been thought of as a hospital-focused disease, but there is increasing recognition of transmission outside the hospital,” said first author David P. Durham, associate research scientist in epidemiology.

To determine how the remaining infections spread, the Yale-led team developed a dynamic model to estimate transmission rates in three settings: hospitals, long-term care facilities, and the general community.

They found that hospitalized patients with symptoms of C. diff infection transmitted it at a rate 15 times higher than asymptomatic patients, even after accounting for infection control measures.

The rates of transmission among residents in long-term care facilities and in the community were 27% and 0.1% that of hospitalized patients, respectively.

“The latter rates are lower but still important sources of transmission, due to the much larger population outside of the hospital setting,” said co-author Jeffrey Townsend, associate professor of public health.

The findings point to the need to account for asymptomatic carriers and community sources in efforts to prevent and control C. diff infection, the researchers noted.

The study was published on March 16 in Emerging Infectious Diseases. Other authors include Yale professor Alison Galvani and Washington University researchers Erik Dubberke and Margaret Olsen.