C difficile May Spread More Widely in ICUs Than Previously Thought

A new study has found that C difficile may spread “more widely in ICUs than previously understood.” CIDRAP has the news.

The findings are “based on genomic analysis of C difficile isolates collected from two ICUs in Utah in 2018…C difficile causes severe diarrhea and is a leading cause of HAIs around the world, accounting for 223,000 hospitalizations and 12,800 deaths in the United States each year.” This study included “sampling of healthcare provider (HCP) hands and the hospital environment” in addition to patient samples, which provide the basis for most existing genomic studies.

Using these different methods helped researchers find that “movement of the pathogen was more than threefold higher than if they had relied on patient sampling alone.” They collected daily samples from “three patient body sites, three surfaces in patient rooms (patient touch surfaces, HCP touch services, and toilet surfaces), and hands or gloves of HCPs who cared for the patient.” They then “conducted whole genome sequencing (WGS) on both toxigenic and nontoxigenic C difficile isolates to identify transmission clusters.”

7,000 samples were collected in total across 278 unique ICU admissions, and 177 patients consented to body-site sampling. Researchers recovered 178 C difficile isolates: “46 from patient body sites, 87 from patient rooms, 1 from a shared environmental surface, and 44 from HCP hands.” WGS analysis “identified seven transmission clusters involving 22 (7.7%) of 287 occupant stays.” Two included isolates “from two distinct occupants’ body sites, suggesting patient-to-patient transmission, while two others included environmental or HCP hand isolates and patient isolates, which means a patient acquired from or shed the pathogen into the environment or the hands of an HCP caring for another occupant.”

The authors also noted that “most of the C difficile isolates were nontoxigenic and that only two patients, both in the same hospitals, were identified as having” infections. However, the frequency with which isolates were found from environmental surfaces and HCP hands suggests transmission in ICUs has been “underestimated in previous studies.”