C. difficile Colonization and Risk for Subsequent CDI

Douglas K. Rex, MD reviewing Zacharioudakis IM et al. Am J Gastroenterol 2015 Mar.

In a meta-analysis, risk for clinical Clostridium difficile infection was increased sixfold in those who were colonized when admitted.

Early studies suggested that Clostridium difficile colonization in hospitalized patients actually predicted a lower risk for clinical C. difficile infection (CDI). Now, researchers have conducted a meta-analysis and systematic review to explore this issue. Nineteen prospective studies involving a total of 8725 inpatients were included in the final analysis.

The prevalence of toxinogenic C. difficile colonization at admission was 8.1% overall — and 10.0% in studies conducted in North America — with the rates increasing significantly over time. The risk for developing clinical CDI (defined as ≥3 unformed stools within 24 hours and stool-test results positive for toxinogenic C. difficile or its toxins) was 21.8% in colonized patients compared with 3.4% in noncolonized patients. The likelihood of colonization was significantly higher in individuals with hospitalization during the preceding 3 months but not in those with previous antibiotic or proton-pump inhibitor (PPI) use or a history of CDI.

CITATION(S):

Zacharioudakis IM et al. Colonization with toxinogenic C. difficile upon hospital admission, and risk of infection: A systematic review and meta-analysis. Am J Gastroenterol 2015 Mar; 110:381.