Am J Gastroenterol 2015 Mar. has an interesting article on Clostridium difficile colonization and interesting finding based on data meta-analysis byDouglas K. Rex, MD reviewing Zacharioudakis IM et al.
In a meta-analysis, risk for clinical Clostridium difficile infection was increased six fold in those who were colonized when admitted.
Early studies suggested that Clostridium difficile colonization in hospitalized patients actually predicted a lower risk for clinical C. difficile infection (CDI). Now, researchers have conducted a meta-analysis and systematic review to explore this issue. Nineteen prospective studies involving a total of 8725 inpatients were included in the final analysis.
The prevalence of toxinogenicC. difficile colonization at admission was 8.1% overall — and 10.0% in studies conducted in North America — with the rates increasing significantly over time. The risk for developing clinical CDI (defined as ≥3 unformed stools within 24 hours and stool-test results positive for toxinogenicC. difficile or its toxins) was 21.8% in colonized patients compared with 3.4% in non-colonized patients. The likelihood of colonization was significantly higher in individuals with hospitalization during the preceding 3 months but not in those with previous antibiotic or proton-pump inhibitor (PPI) use or a history of CDI.
CDI has become an enormous and devastating problem in hospitalized patients. These data suggest that a significant proportion of the C. difficile burden is brought into the hospital as patients are admitted and that antibiotic and PPI use contribute to progress from colonization to infection but not to establishment of colonization. The findings highlight the importance of identifying carriers on admission and implementing measures to prevent both transmission and progression to CDI.