CDI Risk Higher in Subsequent Hospital Bed Patients

Hospital patients who followed a prior bed occupant that received antibiotics had an increased risk for contracting Clostridium difficile infection (CDI), according to a new study.

Researchers at New York-Presbyterian Hospital/Columbia University Medical Center (NYP; New York, NY, USA) and Columbia University Medical Center (CUMC, New York, NY, USA) conducted a retrospective cohort study of 100,615 paired adult patients hospitalized between 2010 and 2015. Patients were excluded if they had recent CDI, developed CDI within 48 hours of admission, had inadequate follow-up time, or if their prior bed occupant was in the bed for less than 24 hours.

The primary exposure was receipt of antibiotics by the prior bed occupant, and the primary outcome was incident CDI in the subsequent patient to occupy the same bed, defined as a positive result from a stool polymerase chain reaction (PCR) for the C difficile toxin B gene, followed by treatment for CDI. In all, 576 (0.57%) of the secondary patients developed CDI within 2 to 14 days, representing a 22% hazard ratio after adjustment for CDI risk factors, including receipt of antibiotics by the second patient. The study was published on October 10, 2016, in JAMA Internal Medicine.

“These data imply that patient-to-patient transmission of C. difficile or other bacteria that mediate susceptibility to CDI takes place in the non-outbreak setting and in the face of a multifaceted effort seeking to prevent healthcare-associated CDI,” concluded lead author Daniel Freedberg, MD, MSc, of NYP, and colleagues. “Antibiotics may affect the gastrointestinal microbiome more globally to decrease bacterial species that are protective against C. difficile or to increase bacterial species that facilitate C. difficile. Subsequent patient-to-patient transmission of these bacterial species may then drive risk for CDI in future patients.”

CDI is a serious illness resulting from infection of the internal lining of the colon by C. difficile bacteria, and typically develops after the use of broad-spectrum antibiotics that disrupt normal bowel flora. C. difficile exists in the environment as a dormant spore; to colonize the gut, the spores need to germinate and turn in active, toxin-producing bacteria. Antibiotics that alter gastrointestinal microbiota facilitate this germination, leading to CDI, the leading cause of nosocomial diarrhea in industrialized countries.

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New York-Presbyterian Hospital
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