Abstract
Stephan Harbarth and Matthew Samore discuss the implications, and the limitations, of new research that might indicate that most Clostridium difficile cases are imported into hospitals.
Highlights
Evidence for the rate of nosocomial acquisition of C. difficile and the likelihood of within-hospital transmission from patients to patients of C. difficile infection remains scarce, so an improved evidence base could help improve infection control strategies [8]
15 years ago, Samore et al reported that for most epidemiologically linked contacts of C. difficile cases, positive cultures for C. difficile did not result from transmission from the presumed index case [8]
This and other studies were conducted before the emergence of new hypervirulent C. difficile strains and might not reflect the current epidemiology of C. difficile transmission
Summary
This Perspective discusses the following new study published in PLoS Medicine: Walker AS, Eyre DW, Wyllie DH, Dingle KE, Harding RM, et al (2012) Characterisation of Clostridium difficile Hospital Ward–Based Transmission Using Extensive Epidemiological Data and Molecular Typing. Strain types, and patient location as plausibility checks, the authors propose that within-hospital transmission accounted for a relatively small number of the overall C. difficile cases detected. This study suggests that alternative explanations need to be sought for the origin of most of the new onset cases of C. difficile infection. This impressive study addresses an important question—to what extent can we control C. difficile infection by prevention of transmission from symptomatic C. difficile infection cases in hospitals? Transmission events linked to asymptomatic carriers were not routinely detected [11]
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