Screening for Clostridioides difficile colonization at admission to the hospital: a multi-centre study

Monique J.T. Crobach*, Bastian V.H. Hornung, Cees Verduin, Margreet C. Vos, Joost Hopman, Nitin Kumar, Celine Harmanus, Ingrid Sanders, Elisabeth M. Terveer, Mark D. Stares, Trevor D. Lawley, Ed J. Kuijper

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)
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Objectives: To assess the value of screening for Clostridioides difficile colonization (CDC) at hospital admission in an endemic setting. Methods: A multi-centre study was conducted at four hospitals located across the Netherlands. Newly admitted patients were screened for CDC. The risk of development of Clostridioides difficile infection (CDI) during admission and 1-year follow-up was assessed in patients with and without colonization. C. difficile isolates from patients with colonization were compared with isolates from incident CDI cases using core genome multi-locus sequence typing to determine whether onwards transmission had occurred. Results: CDC was present in 108 of 2211 admissions (4.9%), whereas colonization with a toxigenic strain (toxigenic Clostridoides difficile colonization [tCDC]) was present in 68 of 2211 admissions (3.1%). Among these 108 patients with colonization, diverse PCR ribotypes were found and no ‘hypervirulent’ PCR ribotype 027 (RT027) was detected (95% CI, 0–0.028). None of the patients with colonization developed CDI during admission (0/49; 95% CI, 0–0.073) or 1-year follow-up (0/38; 95% CI, 0–0.93). Core genome multi-locus sequence typing identified six clusters with genetically related isolates from patients with tCDC and CDI; however, in these clusters, only one possible transmission event from a patient with tCDC to a patient with CDI was identified based on epidemiological data. Conclusion: In this endemic setting with a low prevalence of ‘hypervirulent’ strains, screening for CDC at admission did not detect any patients with CDC who progressed to symptomatic CDI and detected only one possible transmission event from a patient with colonization to a patient with CDI. Thus, screening for CDC at admission is not useful in this setting.

Original languageEnglish
Pages (from-to)891-896
Number of pages6
JournalClinical Microbiology and Infection
Issue number7
Publication statusPublished - Jul 2023

Bibliographical note

Funding Information:
The authors declare that they have no conflicts of interest. This work was supported by the Netherlands Organisation for Health Research and Development, ZonMW (grant 50-52200-98-035) and Wellcome Sanger core funding (WT098051).

Publisher Copyright:
© 2023 The Authors


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