Format

Send to

Choose Destination
J Microbiol Immunol Infect. 2015 Jun;48(3):241-8. doi: 10.1016/j.jmii.2014.04.011. Epub 2014 Jun 2.

Clinical impact of Clostridium difficile colonization.

Author information

1
Department of Internal Medicine, Ministry of Health & Welfare, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University, Medical College and Hospital, Tainan, Taiwan; Graduate Institute of Clinical Medicine, National Health Research Institutes, Tainan, Taiwan.
2
Department of Internal Medicine, National Cheng Kung University, Medical College and Hospital, Tainan, Taiwan.
3
Department of Internal Medicine, Ministry of Health & Welfare, Tainan, Taiwan.
4
Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan.
5
Department of Medical Laboratory Science and Biotechnology, National Cheng Kung University, Medical College, Tainan, Taiwan; Center of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan, Taiwan. Electronic address: peijtsai@mail.ncku.edu.com.
6
Department of Internal Medicine, National Cheng Kung University, Medical College and Hospital, Tainan, Taiwan. Electronic address: winston3415@gmail.com.

Abstract

Clostridium difficile can cause antibiotic-associated diarrhea in hospitalized patients. Asymptomatic colonization by C. difficile is common during the neonatal period and early infancy, ranging from 21% to 48%, and in childhood. The colonization rate of C. difficile in adult hospitalized patients shows geographic variation, ranging from 4.4% to 23.2%. Asymptomatic carriage in neonates caused no further disease in many studies, whereas adult patients colonized with toxigenic C. difficile were prone to the subsequent development of C. difficile-associated diarrhea (CDAD). However, the carriage of nontoxigenic C. difficile strains appears to prevent CDAD in hamsters and humans. Risk factors for C. difficile colonization include recent hospitalization, exposure to antimicrobial agents or gastric acid-suppressing drugs (such as proton-pump inhibitors and H2 blockers), a history of CDAD or cytomegalovirus infection, the presence of an underlying illness, receipt of immunosuppressants, the presence of antibodies against toxin B, and Toll-like receptor 4 polymorphisms. Asymptomatic C. difficile carriers are associated with significant skin and environmental contamination, similar to those with CDAD, and contact isolation and hand-washing practices should therefore be employed as infection control policies for the prevention of C. difficile spread. Treating patients with asymptomatic C. difficile colonization with metronidazole or vancomycin is not suggested by the currently available evidence. In conclusion, asymptomatic C. difficile colonization may lead to skin and environmental contamination by C. difficile, but more attention should be paid to the clinical impact of those with C. difficile colonization.

KEYWORDS:

C. difficile-associated diarrhea; Clostridium difficile colonization; Environment contamination; Nontoxigenic C. difficile; Risk factor; Toxigenic C. difficile

PMID:
24890755
DOI:
10.1016/j.jmii.2014.04.011
[Indexed for MEDLINE]
Free full text

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center