Objectives

The aim was to compare the burden of environmental shedding of toxigenic Clostridioides difficile among asymptomatic carriers, C. difficile-infected (CDI) patients and non-carriers in an inpatient non-epidemic setting.

Methods

C. difficile carriage was determined by positive toxin-B PCR from rectal swabs of asymptomatic patients. Active CDI was defined as a positive two-step enzyme immunoassay/polymerase chain reaction (EIA/PCR) test in patients with more than three unformed stools/24 hr. C. difficile environmental contamination was assessed by obtaining specimens from ten sites in the patients' rooms. Toxigenic strains were identified by PCR. We created a contamination scale to define the overall level of room contamination that ranged from clean to heavy contamination.

Results

One hundred and seventeen rooms were screened: 70 rooms inhabited by C. difficile carriers, 30 rooms by active CDI patients and 17 rooms by non C. difficile -carriers (control). In the carrier rooms 29 (41%) had more than residual contamination, from which 17 (24%) were heavily contaminated. In the CDI rooms 12 (40%) had more than residual contamination from which three (10%) were heavily contaminated, while in the control rooms, one room (6%) had more than residual contamination and none were heavily contaminated. In a multivariate analysis, the contamination score of rooms inhabited by carriers did not differ from rooms of CDI patients, yet both were significantly more contaminated than those of non-carriers odd ratio 12.23 and 11.16 (95% confidence interval 1.5–99.96 p 0.0195, and 1.19–104.49 p 0.035), respectively.

Discussion

Here we show that the rooms of C. difficile carriers are as contaminated as those of patients with active CDI and significantly more than those of non-carriers.

中文翻译：

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无症状携带者对艰难梭菌产毒的环境影响：一项前瞻性观察研究。

目标

目的是比较无症状携带者，艰难梭菌感染（CDI）患者和非携带者在住院非流行环境中难产的产毒梭状梭菌的环境负担。

方法

通过阳性无症状患者直肠拭子的毒素B PCR阳性检测艰难梭菌。活跃的CDI被定义为粪便超过三个未形成的患者/ 24小时的阳性两步酶免疫测定/聚合酶链反应（EIA / PCR）测试。C.艰难环境的污染是通过从患者的房间十个站点获取标本进行评估。通过PCR鉴定产毒菌株。我们创建了一个污染等级，以定义房间污染的总体水平，从干净到重度不等。

结果

筛选了一百一十七个房间：C居住了70个房间。艰难的携带者，活跃的CDI患者有30个房间，非C则有17个房间。艰难的-载体（控制）。在运送室中，有29个（41％）的残留污染多，其中17个（24％）被严重污染。在CDI室中，有12个（40％）的残留污染多，其中三个（10％）受到严重污染，而在控制室中，一个房间（6％）的污染大于残留污染，没有一个被严重污染。在多变量分析中，携带者居住的房间的污染评分与CDI患者的房间没有差异，但是相比非携带者奇数比分别为12.23和11.16（95％置信区间1.5–99.96 p 0.0195，和1.19–104.49 p 0.035）。

讨论区

在这里，我们显示艰难梭菌携带者的房间与活动性CDI患者的房间一样被污染，并且比非携带者的房间污染的人明显更多。