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Volume 48, Number 3, June 2015

Clinial impact of Clostridium difficle colonization


Yuan-Pin Hung, Jen-Chieh Lee, Hsiao-Ju Lin, Hsiao-Chieh Liu, Yi-Hui Wu, Pei-Jane Tsai, Wen-Chien Ko


Received: March 31, 2014    Revised: April 12, 2014    Accepted: April 21, 2014   

 

Corresponding author:

Wen-Chien Ko
Department of Internal Medicine, National Cheng Kung University, Medical College and Hospital, Tainan, Taiwan
Correspondence
Corresponding author. Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, 138 Sheng Li Road, Tainan, 70403, Taiwan.

Pei-Jane Tsai
Department of Medical Laboratory Science and Biotechnology, National Cheng Kung University, Medical College, Tainan, Taiwan
Center of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan, Taiwan
Correspondence
Corresponding author. Department of Medical Laboratory Science and Biotechnology, National Cheng Kung University, Medical College, 1 University Road, Tainan, 70101, Taiwan. 



 

Background and purpose: 

Clostridium difficile can cause antibiotic-associated diarrhea in hospitalized patients. Asymptomatic colonization by C. difficile is common during the neonatal period and early infancy, ranging from 21% to 48%, and in childhood. The colonization rate of C. difficile in adult hospitalized patients shows geographic variation, ranging from 4.4% to 23.2%. Asymptomatic carriage in neonates caused no further disease in many studies, whereas adult patients colonized with toxigenic C. difficile were prone to the subsequent development of C. difficile-associated diarrhea (CDAD). However, the carriage of nontoxigenic C. difficile strains appears to prevent CDAD in hamsters and humans. Risk factors for C. difficile colonization include recent hospitalization, exposure to antimicrobial agents or gastric acid-suppressing drugs (such as proton-pump inhibitors and H2 blockers), a history of CDAD or cytomegalovirus infection, the presence of an underlying illness, receipt of immunosuppressants, the presence of antibodies against toxin B, and Toll-like receptor 4 polymorphisms. Asymptomatic C. difficile carriers are associated with significant skin and environmental contamination, similar to those with CDAD, and contact isolation and hand-washing practices should therefore be employed as infection control policies for the prevention of C. difficile spread. Treating patients with asymptomatic C. difficile colonization with metronidazole or vancomycin is not suggested by the currently available evidence. In conclusion, asymptomatic C. difficile colonization may lead to skin and environmental contamination by C. difficile, but more attention should be paid to the clinical impact of those with C. difficile colonization. 



 

Key words:

Clostridium difficile colonization, C. difficile-associated diarrhea, Environment contamination, Nontoxigenic C. difficile, Risk factor, Toxigenic C. difficile