A Clostridioides difficile active surveillance program to identify positive high-risk patients on admit

Area of Science:

• Infectious Diseases
• Hospital Epidemiology
• Microbiology

Background:

• Clostridioides difficile (CD) infection presents significant morbidity, mortality, and economic challenges.
• Healthcare-associated CD infection (HA-CDI) is defined by specific testing criteria and timing.
• Distinguishing HA-CDI from community-acquired CDI or colonization is crucial for effective management.

Purpose of the Study:

• To evaluate the feasibility and potential impact of early identification of high-risk patients for CD colonization upon hospital admission.
• To assess if proactive CD screening can aid in reducing HA-CDI rates and transmission within healthcare settings.

Main Methods:

• A prospective study conducted from July 2022 to December 2023.
• Identified high-risk patients based on criteria: readmission, long-term care facility admission, chronic wounds, or tracheostomy/catheters.
• Collected stool specimens prior to hospital day three for CD testing.

Main Results:

• 822 high-risk patients were identified; stool samples were collected from 165.
• 42 (25%) of collected samples tested positive for CD.
• 21 samples were cancelled for formed stool; 7 of these were positive upon research lab testing.

Conclusions:

• Early identification of high-risk patients for CD colonization on admission is a viable strategy.
• Proactive CD status determination supports targeted interventions like environmental disinfection, hand hygiene, antibiotic stewardship, and isolation protocols.
• This approach has the potential to decrease HA-CDI rates and improve patient safety.