Abstract
BackgroundClostridioides difficile is considered the main pathogen responsible for hospital-acquired infections. This prospective study determined the prevalence, molecular epidemiological characteristics, and risk factors for C. difficile infection (CDI) and C. difficile colonization (CDC) among patients in the intensive care unit (ICU) of a large-scale tertiary hospital in China, with the aim of providing strategies for efficient CDI and CDC prevention and control.MethodsStool samples were collected and anaerobically cultured for C. difficile detection. The identified isolates were examined for toxin genes and subjected to multilocus sequence typing. Patients were classified into CDI, CDC, and control groups, and their medical records were analyzed to determine the risk factors for CDI and CDC.ResultsOf the 800 patients included in the study, 33 (4.12%) and 25 (3.12%) were identified to have CDI and CDC, respectively. Associations with CDI were found for fever (OR = 13.993), metabolic disorder (OR = 7.972), and treatment with fluoroquinolone (OR = 42.696) or combined antibiotics (OR = 2.856). CDC patients were characterized by prolonged hospital stay (OR = 1.137), increased number of comorbidities (OR = 36.509), respiratory diseases (OR = 0.043), and treatment with vancomycin (OR = 18.168). Notably, treatment with metronidazole was found to be a protective factor in both groups (CDI: OR = 0.042; CDC: OR = 0.013). Eighteen sequence types (STs) were identified. In the CDI group, the isolated strains were predominantly toxin A and toxin B positive (A + B+) and the epidemic clone was genotype ST2. In the CDC group, the dominant strains were A + B+ and the epidemic clone was ST81.ConclusionsThe prevalences of CDC and CDI in our ICU were relatively high, suggesting the importance of routine screening for acquisition of C. difficile. Future prevention and treatment strategies for CDC and CDI should consider hospital stay, enteral nutrition, underlying comorbidities, and use of combined antibiotics. Moreover, metronidazole may be a protective factor for both CDI and CDC, and could be used empirically.
Highlights
Clostridioides difficile is considered the main pathogen responsible for hospital-acquired infections
115 developed diarrhea and 33 (28.70%) were identified to have C. difficile infection (CDI). Another 25 toxigenic C. difficile strains were isolated from patients without diarrhea, and defined as C. difficile colonization (CDC) cases
The results showed that fever, metabolic disorder, and treatment with fluoroquinolone or combined antibiotics were risk factors associated with development of CDI among intensive care unit (ICU) patients
Summary
Clostridioides difficile is considered the main pathogen responsible for hospital-acquired infections. This prospective study determined the prevalence, molecular epidemiological characteristics, and risk factors for C. difficile infection (CDI) and C. difficile colonization (CDC) among patients in the intensive care unit (ICU) of a large-scale tertiary hospital in China, with the aim of providing strategies for efficient CDI and CDC prevention and control. C. difficile can colonize individuals without causing detectable symptoms of infection Such asymptomatic C. difficile-colonized patients may present a potential risk to other susceptible individuals by acting as infection reservoirs [8, 9]. It is considered that asymptomatic C. difficile-colonized patients may serve as potential vehicles for C. difficile transmission in medical settings [10], where there is a significantly higher risk of CDI [11]. The global spread of emerging hypervirulent toxigenic strains is of particular concern [12]
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