Division of Infectious Diseases, Medical University of South Carolina, Charleston, USA.
Division of Infectious Diseases, MetroHealth Medical Center, USA.
Clin Infect Dis. 2023 Jul 5;77(1):77-83. doi: 10.1093/cid/ciad142.
Limited information is available on the natural history of Clostridioides difficile colonization and infection in patients with new acquisition of C. difficile in healthcare settings.
In 3 hospitals and affiliated long-term care facilities, we collected serial perirectal cultures from patients with no diarrhea on enrollment to identify new acquisition of toxigenic C. difficile carriage and determined the duration and burden of carriage. Asymptomatic carriage was defined as transient if only 1 culture was positive, with negative cultures before and after, or persistent if 2 or more cultures were positive. Clearance of carriage was defined as 2 consecutive negative perirectal cultures.
Of 1432 patients with negative initial cultures and at least 1 follow-up culture, 39 (2.7%) developed C. difficile infection (CDI) without prior detection of carriage and 142 (9.9%) acquired asymptomatic carriage, with 19 (13.4%) subsequently diagnosed with CDI. Of 82 patients analyzed for persistence of carriage, 50 (61.0%) had transient carriage and 32 (39.0%) had persistent carriage, with an estimated median of 77 days to clearance of colonization (range, 14-133 days). Most persistent carriers had a relatively high burden of carriage and maintained the same ribotype over time, whereas most transient carriers had a low burden of carriage detected only using broth enrichment cultures.
In 3 healthcare facilities, 9.9% of patients acquired asymptomatic carriage of toxigenic C. difficile, and 13.4% were subsequently diagnosed with CDI. Most carriers had transient rather than persistent carriage and most patients developing CDI did not have prior detection of carriage.
在医疗机构中新获得艰难梭菌（C. difficile）的患者中，关于艰难梭菌定植和感染的自然史，相关信息有限。
在 3 家医院和附属长期护理机构中，我们从无腹泻的入组患者中收集直肠周围连续培养物，以确定新获得产毒艰难梭菌定植情况，并确定定植的持续时间和负荷。无症状定植定义为如果仅 1 次培养物阳性，前后均为阴性，或如果 2 次或更多次培养物阳性，则为持续性。清除定植定义为 2 次连续直肠周围培养物阴性。
在 1432 例初始培养物阴性且至少有 1 次随访培养物的患者中，39 例（2.7%）在无定植检测前发生艰难梭菌感染（CDI），142 例（9.9%）获得无症状定植，其中 19 例（13.4%）随后诊断为 CDI。在 82 例分析定植持续性的患者中，50 例（61.0%）为一过性定植，32 例（39.0%）为持续性定植，估计定植清除的中位时间为 77 天（范围，14-133 天）。大多数持续性定植者的定植负荷较高，且随时间推移保持相同的核糖体型，而大多数一过性定植者的定植负荷较低，仅通过肉汤富集培养物检测到。
在 3 家医疗机构中，9.9%的患者获得了产毒艰难梭菌的无症状定植，其中 13.4%随后诊断为 CDI。大多数定植者为一过性而非持续性，大多数发生 CDI 的患者未检测到定植。
