Internal Medicine D, Sheba Medical Centre, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Disease Unit, Sheba Medical Centre, Ramat Gan, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Internal Medicine B, Sheba Medical Centre, Ramat Gan, Israel.
Clin Microbiol Infect. 2020 Aug;26(8):1052-1057. doi: 10.1016/j.cmi.2019.12.011. Epub 2020 Jan 3.
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.
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.
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.
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.
本研究旨在比较无症状携带者、感染艰难梭菌（CDI）患者和非携带者在非流行时期住院环境中艰难梭菌产毒株的环境脱落负担。
采用毒素 B PCR 法检测无症状患者直肠拭子中艰难梭菌的携带情况。对粪便次数≥3 次/24 小时且两步酶联免疫吸附试验/聚合酶链反应（EIA/PCR）检测阳性的患者定义为 CDI 活跃期。通过从患者病房的 10 个部位获取标本来评估艰难梭菌的环境污染情况。采用 PCR 方法鉴定产毒菌株。我们创建了一个污染程度评分标准，以定义房间污染的总体水平，范围从清洁到严重污染。
共筛查了 117 个房间：70 个房间由艰难梭菌携带者居住，30 个房间由 CDI 活跃期患者居住，17 个房间由非艰难梭菌携带者（对照组）居住。在携带者居住的房间中，有 29 个（41%）房间存在残留污染，其中 17 个（24%）房间污染严重。在 CDI 患者居住的房间中，有 12 个（40%）房间存在残留污染，其中 3 个（10%）房间污染严重，而在对照组的房间中，有 1 个（6%）房间存在残留污染，没有房间污染严重。多变量分析显示，携带者居住房间的污染评分与 CDI 患者房间的污染评分没有差异，但两者的污染程度均明显高于非携带者的房间，比值比（OR）分别为 12.23（95%置信区间（CI）1.5-99.96，p=0.0195）和 11.16（95%CI 1.19-104.49，p=0.035）。
本研究表明，艰难梭菌携带者的房间污染程度与 CDI 活跃期患者的房间污染程度相当，且明显高于非携带者的房间。
