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

Part of: BARRY FARR AWARD RECIPIENTS

Published online by Cambridge University Press:  02 January 2015

Ajay K. Sethi ,
Wafa N. Al-Nassir ,
Michelle M. Nerandzic ,
Greg S. Bobulsky  and
Curtis J. Donskey
Ajay K. Sethi
Affiliation:
Departments of Epidemiology and Biostatistics, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
Wafa N. Al-Nassir
Affiliation:
Infectious Diseases, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
Michelle M. Nerandzic
Affiliation:
University Hospitals of Cleveland, Case Western, Reserve University School of Medicine, and the Research Service, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
Greg S. Bobulsky
Affiliation:
University Hospitals of Cleveland, Case Western, Reserve University School of Medicine, and the Research Service, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
Curtis J. Donskey*
Affiliation:
University Hospitals of Cleveland, Case Western, Reserve University School of Medicine, and the Research Service, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio Geriatric Research, Education, and Clinical Center, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
*
Infectious Diseases Section (1110 W), Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, Ohio 44106 (curtisdl23@yahoo.com)
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Extract

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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 1 , January 2010 , pp. 21 - 27
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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