EPIDEMIOLOGICAL MODEL FOR CLOSTRIDIUM DIFFICILE TRANSMISSION IN HEALTH-CARE SETTINGS
Published Date:Jun 2011
Source:Infect Control Hosp Epidemiol. 32(6):553-561.
Pubmed Central ID:PMC3645005
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
N01-AI-30054/AI/NIAID NIH HHS/United States
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.
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.
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).
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.
Our study underscores the need to further evaluate the role of asymptomatically colonized patients in C. difficile transmission in the healthcare setting.
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