A recent study published in Nature Medicine has revealed surprising findings about Clostridioides difficile (C. diff) infections. C. diff is a bacterium that causes severe diarrhea and colitis. Despite rigorous infection prevention methods, hospital-onset C. diff infections persist. However, the new study suggests that these infections may be more related to patient characteristics and colonization rather than direct transmission within hospitals.
The study, led by researchers from the University of Michigan Medical School and Rush University Medical Center, analyzed daily fecal samples from every patient in the intensive care unit at Rush University Medical Center over a nine-month period. They found that over 9% of the patients were colonized with C. diff.
The researchers used whole genome sequencing to analyze C. diff strains isolated from fecal samples. Surprisingly, there was very little evidence of transmission between patients, with only six cases supported by genomic analysis. Instead, the study found that people who were already colonized with C. diff were at a greater risk of developing an infection.
The researchers emphasized that this does not mean hospital infection prevention measures are unnecessary. The measures in place at the time of the study were likely responsible for the low transmission rate. However, the study highlights the need for additional steps to identify patients who are colonized with C. diff and prevent infection in them.
C. diff is a bacterium that is all around us, but only about 5% of the population outside of healthcare settings have it in their gut without experiencing any issues. The researchers emphasized the need to find ways to prevent patients from developing infections when they are exposed to risk factors such as tube feedings, antibiotics, and proton pump inhibitors.
The team plans to further investigate the use of artificial intelligence models to predict patients at risk of C. diff infections. They believe that redirecting resources to optimize the use of antibiotics and identify triggers for serious infections could lead to better prevention strategies.
In conclusion, this study suggests that C. diff infections may be more patient-related than a result of hospital transmission. Identifying and preventing infections in patients who are already colonized with C. diff is crucial to reducing the burden of these infections.
Reference:
“Longitudinal genomic surveillance of carriage and transmission of Clostridioides difficile in an intensive care unit” by Arianna Miles-Jay, Evan S. Snitkin, Michael Y. Lin, Teppei Shimasaki, Michael Schoeny, Christine Fukuda, Thelma Dangana, Nicholas Moore, Sarah E. Sansom, Rachel D. Yelin, Pamela Bell, Krishna Rao, Micah Keidan, Alexandra Standke, Christine Bassis, Mary K. Hayden and Vincent B. Young, 18 September 2023, Nature Medicine. DOI: 10.1038/s41591-023-02549-4
The study was funded by the National Institutes of Health and the Centers for Disease Control and Prevention.
Additional authors include Arianna Miles-Jay, Michael Y. Lin, Teppei Shimasaki, Michael Schoeny, Christine Fukuda, Thelma Dangana, Nicholas Moore, Sarah E. Sansom, Rachel D. Yelin, Pamela Bell, Krishna Rao, Micah Keidan, Alexandra Standke, and Christine Bassis.
