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Household Transmission of Clostridium difficile to Family Members and Domestic Pets

  • Vivian G. Loo (a1), Paul Brassard (a1) and Mark A. Miller (a2)
Abstract
OBJECTIVE

To determine the risk of Clostridium difficile transmission from index cases with C. difficile infection (CDI) to their household contacts and domestic pets.

DESIGN

A prospective study from April 2011 to June 2013.

SETTING

Patients with CDI from Canadian tertiary care centers.

PARTICIPANTS

Patients with CDI, their household human contacts, and pets.

METHODS

Epidemiologic information and stool or rectal swabs were collected from participants at enrollment and monthly for up to 4 months. Pulsed-field gel electrophoresis (PFGE) was performed on C. difficile isolates. Probable transmission was defined as the conversion of a C. difficile culture–negative contact to C. difficile culture–positive contact with a PFGE pattern indistinguishable or closely related to the index case. Possible transmission was defined as a contact with a positive C. difficile culture at baseline with a strain indistinguishable or closely related to the index case.

RESULTS

A total of 51 patients with CDI participated in this study; 67 human contacts and 15 pet contacts were included. Overall, 9 human contacts (13.4%) were C. difficile culture positive; 1 contact (1.5%) developed CDI; and 8 contacts were asymptomatic. Of 67 human contacts, probable transmission occurred in 1 human contact (1.5%) and possible transmission occurred in 5 human contacts (7.5%). Of 15 pet contacts, probable transmission occurred in 3 (20%) and possible transmission occurred in 1 (6.7%).

CONCLUSIONS

There was a high proportion of C. difficile culture positivity at 13.4% among human contacts and asymptomatic carriage of domestic pets reached 26.7%. These results suggest that household transmission of C. difficile may be a source of community-associated cases.

Infect Control Hosp Epidemiol 2016;1–7

Copyright
Corresponding author
Address correspondence to Dr Vivian G. Loo, Division of Infectious Diseases and Department of Microbiology, McGill University Health Centre, 1001 Décarie Blvd. Room E05.1824, Montréal, Québec, Canada, H4A 3J1 (vivian.loo@mcgill.ca).
References
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1. McDonald LC, Killgore GE, Thompson A, et al. An epidemic, toxin gene-variant strain of Clostridium difficile . N Engl J Med 2005;353:24332441.
2. Loo VG, Poirier L, Miller MA, et al. A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med 2005;353:24422449.
3. Kuijper EJ, Coignard B, Tull P, et al. Emergence of Clostridium difficile-associated disease in North America and Europe. Clin Microbiol Infect 2006;12(Suppl 6):218.
4. Lessa FC, Mu Y, Bamberg WM, et al. Burden of Clostridium difficile infection in the United States. N Engl J Med 2015;372:825834.
5. Chitnis AS, Holzbauer SM, Belflower RM, et al. Epidemiology of community-associated Clostridium difficile infection, 2009 through 2011. JAMA Intern Med 2013;173:13591367.
6. Lessa FC. Community-associated Clostridium difficile infection: how real is it? Anaerobe 2013;24:121123.
7. Dial S, Delaney JAC, Schneider V, Suissa S. Proton pump inhibitor use and risk of community-acquired Clostridium difficile-associated disease defined by prescription for oral vancomycin therapy. CMAJ 2006;175:745748.
8. Noren T, Akerlund T, Back E, et al. Molecular epidemiology of hospital-associated and community-acquired Clostridium difficile infection in a Swedish county. J Clin Microbiol 2004;42:36353643.
9. McFarland LV, Mulligan ME, Kwok RYY, Stamm WE. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med 1989;320:204210.
10. Samore MH, DeGirolami PC, Tlucko A, Lichtenberg DA, Melvin ZA, Karchmer AW. Clostridium difficile colonization and diarrhea at a tertiary care hospital. Clin Infect Dis 1994;18:181187.
11. Wendt JM, Cohen JA, Mu Y, et al. Clostridium difficile infection among children across diverse US geographic locations. Pediatrics 2014;133:651658.
12. Pant C, Deshpande A, Altaf MA, Minocha A, Sferra TJ. Clostridium difficile infection in children: a comprehensive review. Curr Med Res Opin 2013;29:967984.
13. Kociolek LK, Patel SJ, Shulman ST, Gerding DN. Molecular epidemiology of Clostridium difficile infections in children: a retrospective cohort study. Infect Control Hosp Epidemiol 2015;36:445451.
14. Borriello SP, Honour P, Turner T, Barclay F. Household pets as a potential reservoir for Clostridium difficile infection. J Clin Pathol 1983;36:8487.
15. Baishnab D, Banfield KR, Jones K, Scott KS, Weightman NC, Kerr KG. Clostridium difficile infection: it’s a family affair. Infect Control Hosp Epidemiol 2013;34:442443.
16. Kundrapu S, Sunkesula VCK, Jury LA, Sethi AK, Donskey CJ. Utility of perirectal swab specimens for diagnosis of Clostridium difficile infection. Clin Infect Dis 2012;55:15271530.
17. Clabots CR, Gerding SJ, Olson MM, Peterson LR, Gerding DN. Detection of asymptomatic Clostridium difficile carriage by an alcohol shock procedure. J Clin Microbiol 1989;27:23862387.
18. Aspinall ST, Hutchinson DN. New selective medium for isolating Clostridium difficile from faeces. J Clin Pathol 1992;45:812814.
19. Fawley WN, Wilcox MH. Pulsed-field gel electrophoresis can yield DNA fingerprints of degradation-susceptible Clostridium difficile strains. J Clin Microbiol 2002;40:35463547.
20. Tenover FC, Arbeit RD, Goering RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:22332239.
21. Rousseau C, Poilane I, De Pontual L, Maherault A-C, Le Monnier A, Collignon A. Clostridium difficile carriage in healthy infants in the community: a potential reservoir for pathogenic strains. Clin Infect Dis 2012;55:12091215.
22. O’Neill G, Adams JE, Bowman RA, Riley TV. A molecular characterization of Clostridium difficile isolates from humans, animals and their environments. Epidemiol Infect 1993;111:257264.
23. Weese JS, Finley R, Reid-Smith RR, Janecko N, Rousseau J. Evaluation of Clostridium difficile in dogs and the household environment. Epidemiol Infect 2010;138:11001104.
24. Shaughnessy MK, Bobr A, Kuskowski MA, et al. Environmental contamination in households of patients with recurrent Clostridium difficile infection. Appl Environ Microbiol 2016;82:26862692.
25. Pepin J, Gonzales M, Valiquette L. Risk of secondary cases of Clostridium difficile infection among household contacts of index cases. J Infect 2012;64:387390.
26. Salipante SJ, SenGupta DJ, Cummings LA, Land TA, Hoogestraat DR, Cookson BT. Application of whole-genome sequencing for bacterial strain typing in molecular epidemiology. J Clin Microbiol 2015;53:10721079.
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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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