Epidemiology and prevention of Clostridium difficile infections in a leukemia unit

A 29-month prospective study was carried out in a leukemia unit with the aim of investigating the epidemiology of Clostridium difficile infections and limiting their spread. Systematic cultures of stools and assays for cytotoxin were performed on patient admission and at weekly intervals, yielding 1,355 cultures and assays. The study period was divided in period A, before total unit renovation, and period B, afterwards. During period B all patient carriers of Clostridium difficile received vancomycin. A comparison of the two periods showed that the percentage of positive cultures fell from 16.6% to 3.6% and the positive toxin assays from 9.9% to 1.2%. It was concluded that colonization by Clostridium difficile can be prevented in hospital wards with generally high rates of infection by a combination of decontamination of the environment, introduction of preventive measures and treatment of Clostridium difficile carriage with vancomycin.