Toxigenic Clostridium difficile colonization among hospitalised adults; risk factors and impact on survival

- Hospitalized adults in our study were commonly colonized by toxigenic Clostridium difficile.
- Risk factors for colonization were previous active C. difficile infection, high risk of malnutrition assessed by Malnutrition Universal Screening Tool score ≥2.
- Patients colonized by C. difficile were at increased risk of death at 90 days.
- C. difficile colonization was not of itself a risk factor for death at 90 days.

SummaryObjectivesTo establish risk factors for Clostridium difficile colonization among hospitalized patients in England.MethodsPatients admitted to elderly medicine wards at three acute hospitals in England were recruited to a prospective observational study. Participants were asked to provide a stool sample as soon as possible after enrolment and then weekly during their hospital stay. Samples were cultured for C. difficile before ribotyping and toxin detection by PCR. A multivariable logistic regression model of risk factors for C. difficile colonization was fitted from univariable risk factors significant at the p < 0.05 level.Results410/727 participants submitted ≥1 stool sample and 40 (9.8%) carried toxigenic C. difficile in the first sample taken. Ribotype 106 was identified three times and seven other ribotypes twice. No ribotype 027 strains were identified. Independent predictors of colonization were previous C. difficile infection (OR 4.53 (95% C.I. 1.33-15.48) and malnutrition (MUST score ≥2) (OR 3.29 (95% C.I. 1.47-7.35)). Although C. difficile colonised patients experienced higher 90-day mortality, colonization was not an independent risk for death.ConclusionsIn a non-epidemic setting patients who have previously had CDI and have a MUST score of ≥2 are at increased risk of C. difficile colonization and could be targeted for active surveillance to prevent C. difficile transmission.