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Persistence of Skin Contamination and Environmental Shedding of Clostridium difficile during and after Treatment of C. difficile Infection

  • Ajay K. Sethi (a1), Wafa N. Al-Nassir (a2), Michelle M. Nerandzic (a3), Greg S. Bobulsky (a3) and Curtis J. Donskey (a3) (a4)...
Abstract
Background.

Current guidelines for control of Clostridium difficile infection (CDI) suggest that contact precautions be discontinued after diarrhea resolves. However, limited information is available regarding the frequency of skin contamination and environmental shedding of C. difficile during and after treatment.

Design.

We conducted a 9-month prospective, observational study involving 52 patients receiving therapy for CDI. Stool samples, skin (chest and abdomen) samples, and samples from environmental sites were cultured for C. difficile before, during, and after treatment. Polymerase chain reaction ribotyping was performed to determine the relatedness of stool, skin, and environmental isolates.

Results.

Fifty-two patients with CDI were studied. C. difficile was suppressed to undetectable levels in stool samples from most patients during treatment; however, 1-4 weeks after treatment, 56% of patients who had samples tested were asymptomatic carriers of C. difficile. The frequencies of skin contamination and environmental shedding remained high at the time of resolution of diarrhea (60% and 37%, respectively), were lower at the end of treatment (32% and 14%, respectively), and again increased 1-4 weeks after treatment (58% and 50%, respectively). Skin and environmental contamination after treatment was associated with use of antibiotics for non-CDI indications. Ninety-four percent of skin isolates and 82% of environmental isolates were genetically identical to concurrent stool isolates.

Conclusions.

Skin contamination and environmental shedding of C. difficile often persist at the time of resolution of diarrhea, and recurrent shedding is common 1-4 weeks after therapy. These results provide support for the recommendation that contact precautions be continued until hospital discharge if rates of CDI remain high despite implementation of standard infection-control measures.

Copyright
Corresponding author
Infectious Diseases Section (1110 W), Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, Ohio 44106 (curtisdl23@yahoo.com)
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1. SM Poutanen , AE Simor . Clostridium difficile-associated diarrhea in adults. CMAJ 2004;171:5158.

2. LC McDonald , GE Killgore , A Thompson , et al. An epidemic, toxin gene-variant strain of Clostridium diffkile. N Engl J Med 2005;353:24332441.

3. VG Loo , L Poirier , MA Miller , et al. A predominandy clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med 2005;353:24422449.

4. CA Muto , M Pokrywka , K Shutt , et al. A large outbreak of Clostridium difficile-associated disease with at unexpected proportion of deaths and colectomies at a teaching hospital following increased fluoroquinolone use. Infect Control Hosp Epidemiol 2005;26:273280.

5. DN Gerding , S Johnson , LR Peterson , ME Mulligan , J Silva . Clostridium difficile-associated diarrhea and colitis. Infect Control Hosp Epidemiol 1995;16:459477.

, , , . . ;:S81-S92.6. ER Dubberke DN Gerding D Classen et alStrategies to prevent infections in acute care hospitalsClostridium difficile Infect Control Hosp Epidemiol 2008 29

7. LV McFarland , GW Elmer , CM Surawicz . Breaking the cycle: treatment strategies for 163 cases of recurrent Clostridium difficile disease. Am J Gastroenterol 2002;97:17691775.

8. G Bobulsky , WN Al-Nassir , MM Riggs , AK Sethi , CJ Donskey . Clostridium difficile skin contamination in patients with C. diffidle-associated disease. Clin Infect Dis 2008;46:447450.

9. WN Al-Nassir , AK Sethi , MM Nerandzic , G Bobulsky , RL Jump , CJ Donskey . Comparison of clinical and microbiological response to treatment of Clostridium difficile-associated disease with metronidazole and vancomycin. Clin Infect Dis 2008;47:5662.

, , , , . . ;:–.11. G Terhes E Urban J Sold KA Hamid E Nagy Community-acquired diarrhea caused b. binary toxin, toxin A, and toxin? gene-positive isolates in HungaryClostridium difficile J Clin Microbiol 2004 42 43164318

12. P Spigaglia , P Mastrantonio . Molecular analysis of the pathogenicity locus and polymorphism in the putative negative regulator of toxin production (TcdC) among Clostridium difficile isolates. J Clin Microbiol 2002;40:34703475.

13. MH Samore , L Vekataraman , PC DeGirolami , RD Arbeit , AW Karchmer . Clinical and molecular epidemiology of sporadic and clustered cases of nosocomial Clostridium difficile. Am J Med 1996;100:3240.

14. MM Riggs , AK Sethi , TF Zabarsky , EC Eckstein , RL Jump , CJ Donskey . Asymptomatic carriers are a potential source for transmission of epidemic and nonepidemic Clostridium difficile strains among long-term care facility residents. Clin Infect Dis 2007;45:992998.

15. CA Muto , MK Blank , JW Marsh , et al. Control of at outbreak of infections with the hypervirulent Clostridium difficile BI strain in a University Hospital using a comprehensive bundle approach. Clin Infect Dis 2007;45:12661273.

, , , , . . ;:–.16. L Valiquette B Cossette MP Garant H Diab J Pepin Impact of a reduction in high-risk antibiotics of the course of an epidemic of disease caused b. the hypervirulent NAPI/027 strainClostridium difficile-associated Clin Infect Dis 2007 45 S112S121

, , , , , . . ;:–.17. MO Vernon MK Hayden WE Trick RA Hayes DW Blom RA Weinstein Chlorhexidine gluconate to cleanse patients in a medical intensive care unit: The effectiveness of source control to reduce the bioburden of vancomycin-resistant enterococci Arch Intern Med 2006 166 306312

18. AN Duckro , DW Blom , EA Lyle , RA Weinstein , MK Hayden . Transfer of vancomycin-resistant enterococci via health care worker hands. Arch Intern Med 2005;165:302307.

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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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