Does Isolating Clostridium Difficile Carriers Shorten Outbreak Duration?

Isolating Clostridium difficile carriers during an outbreak is not associated with a significantly shorter outbreak duration, according to results published in Clinical Infectious Diseases.

The study aimed to investigate the impact of screening and isolating C difficile carriers during C difficile infection (CDI) outbreaks. The study included all patients present on a ward during an outbreak, including a total of 4 outbreaks from 2 academic hospitals.

When an outbreak was detected, the researchers performed unit-wide screenings of all affected patients on the ward using a rectal swab. Patients who were determined to be C difficile carriers were placed under modified contact precautions until discharge from the ward. Patients with CDI were placed under contact precautions per international guidelines.

During the study, 114 patients were screened and 13% (n=15) were found to be C difficile carriers and placed under isolation precautions. In three of the four outbreaks, the number of C difficile carriers detected was 0 or 1. In the fourth outbreak, however, the researchers detected 13 C difficile carriers. Thus, the percentage of carriers varied significantly between outbreaks, from 0% to 29% (P =.004).

The results indicated that there was no difference between the 4 study outbreaks (that involved screening and isolation of C difficile carriers) and the 4 historical controls (that did not involve screening and isolation of carriers) in terms of number of cases of CDI (median, 7.0 vs 7.5 cases, respectively; P >.99) and duration (median, 26.5 vs 34.0 days, respectively; P =.72).

“Screening of asymptomatic patients for C difficile carriage in the context of outbreaks led to the detection of 13% of carriers but was not associated with a shorter duration of outbreak,” the investigators concluded.

Reference

Paquet-Bolduc B, Gervais P, Roussy JF, et al. Detection and isolation of C. difficile asymptomatic carriers during C. difficile infection outbreaks – an exploratory study [published online May 16, 2018].  Clin Inf Dis. doi:10.1093/cid/ciy425/4996545