Decreased risk of subsequent Clostridium difficile -Associated diarrhea (CDAD) in patients with primary asymptomatic colonization by CD

S. Johnson, K. Shim, M. Samore, D. Bliss, Gerding D. Vachs

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Abstract

Primary asymptomatic colonization by CD (exclusive of patients recovering from CD AD) is very common among hospitalized patients, particularly those with long hospital stays. Although these patients may be hypothesized to be at risk for CD AD when exposed to antibiotics, previous studies have suggested otherwise. In order to better define the risk of CDAD in colonized patients, a risk difference meta-analysis was performed on data from four longitudinal studies in which hospitalized patients were followed by prospective rectal swab culture. Of 192 colonized patients followed for 295.5 weeks (mean= 1.5 wks/pt) only 2 patients (1.0%) developed CD AD; of 618 patients who were initially culture-negative and followed for 1066 weeks (mean= 1.7 wks/pt), 22 (3.6%) developed CDAD (p= 0.021, pooled risk difference= 0.0234, 95% CI: -0.0434 to -0.0034). Inclusion of only those patients who received antibiotics (and who were likely at highest risk of CDAD) in the analysis increased the risk difference: 2 of 176 (1.1%) colonized antibiotic recipients versus 22 of 491 (4.5%) non-colonized antibiotic recipients developed CDAD (pooled risk difference= -0.0318, 95% CI: -0.0595 to -0.0041, p= 0.024). Restriction endonuclease analysis (REA) typing indicated colonization by both toxigenic and non-toxigenic CD strains (55% and 45% of patients, respectively). Nine of the 12 toxigenic strains responsible for CDAD were also recovered from the stools of colonized patients. Primary asymptomatic colonization does not predispose to CDAD, but conversely, may be an indication of protection from subsequent symptomatic disease.

Original languageEnglish (US)
Number of pages1
JournalClinical Infectious Diseases
Volume25
Issue number2
StatePublished - Dec 1 1997

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