Details:

Alternative Title:
Infect Control Hosp Epidemiol
Publisher's site:
http://dx.doi.org/10.1086/660013
Personal Author:
Lanzas, C. ; Dubberke, E.R. ; Lu, Z. ; Reske, K.A. ; Gröhn, Y.T.
Lanzas, C. ; Dubberke, E.R. ; Lu, Z. ; Reske, K.A. ; Gröhn, Y.T. Less -
Description:
Objective

Recent outbreaks of Clostridium difficile infection (CDI) have been difficult to control, and data indicate the importance of different sources of transmission may have changed. Our objectives were to evaluate the contributions of asymptomatic and symptomatic C. difficile carriers to new colonizations and to determine the most important epidemiological factors influencing C. difficile transmission.

Design

Retrospective cohort

Setting and Patients

All patients admitted to medical wards at a large tertiary care hospital in the US from Jan 1 to Dec 31, 2008.

Methods

Data from six medical wards and published literature were used to develop a compartmental model of C. difficile transmission. Patients could be in one of five transition states in the model: resistant to colonization (R), susceptible to colonization (S), asymptomatically colonized without protection against CDI (C−), asymptomatically colonized with protection against CDI (C+), and patients with CDI (D).

Results

The contributions of C−, C+ and D patients to new colonizations were similar. The simulated basic reproduction number ranged from .55 to 1.99, with median 1.04. These values suggest that transmission within the ward alone from patients with CDI cannot sustain new C. difficile colonizations, and therefore, the admission of colonized patients plays an important role in sustaining transmission in the ward. The epidemiological parameters that ranked as the most influential were the proportion of admitted C− and the transmission coefficient for asymptomatic carriers.

Conclusion

Our study underscores the need to further evaluate the role of asymptomatically colonized patients in C. difficile transmission in the healthcare setting.


Subject:
[+]
Article
Carrier State
Clostridium Difficile
Clostridium Infections
Cross Infection
Epidemiologic Methods
Hospitals
Humans
Models, Statistical
Retrospective Studies

Source:
Infect Control Hosp Epidemiol. 32(6):553-561.
Pubmed ID:
21558767
Pubmed Central ID:
PMC3645005
Document Type:
Journal Article
Funding:
1 R21 NR011362-01/NR/NINR NIH HHS/United States ; 1K23AI065806-01A2/AI/NIAID NIH HHS/United States ; 5 U01 CI000333-04/CI/NCPDCID CDC HHS/United States ; K23 AI065806/AI/NIAID NIH HHS/United States ; L30 AI062141/AI/NIAID NIH HHS/United States ; ... More +
1 R21 NR011362-01/NR/NINR NIH HHS/United States ; 1K23AI065806-01A2/AI/NIAID NIH HHS/United States ; 5 U01 CI000333-04/CI/NCPDCID CDC HHS/United States ; K23 AI065806/AI/NIAID NIH HHS/United States ; L30 AI062141/AI/NIAID NIH HHS/United States ; N01-AI-30054/AI/NIAID NIH HHS/United States Less -
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:2e74c3529a56c33641c56e40e7ac80f309ae03618718637ab1ed10fb0370b49a
File Type:

Supporting Files

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