A Conversation With Sarah Baron, MD, on Preventing the Progression of C. Diff

A study released last week that found 1 in 10 patients admitted to a New York hospital who did not have diarrhea were found to be carriers of Clostridiodes difficile got a lot of notice, including here at Infection Control Today. The study, published in Infection Control & Hospital Epidemiology, tested 220 patients with no symptoms of C. diff infection who were admitted to Montefiore Medical Center, the University Hospital for Albert Einstein College of Medicine between July 2017 and March 2018. The patients were given perirectal swabs within 24 hours of admission and were then followed for 6 months. Upon admission, 21 of the patients were identified as carriers.

Within 6 months, 38% of the carriers progressed to symptomatic C. diff infection compared with just 2% of the non-carriers, according to a press releasefrom the Society for Healthcare Epidemiology of America, which publishes the journal. ICT reached out to the study’s lead author, Sarah Baron, MD, with some follow-up questions. 

ICT: What is the key takeaway from this study for hospital administrators?

Baron: C. difficile is a concerning infection, at the individual level but also at the level of the hospital and infection prevention. If we want to stop the spread of this disease, we may have to consider novel methods to incorporate the many patients who carry C. difficile, but don’t yet have symptoms. Many of these patients may go on to develop the disease, and frontline staff will require even more support from administration in order to prevent or avoid it. I also hope that this highlights all of the amazing work that our infection prevention and control, environmental services, and antimicrobial stewardship teams do every day to keep our patients as safe as possible. 

ICT: What is the key takeaway for infection preventionists?

Baron: There is a large pool of people who carry C. difficilewho are unrecognized and may pass the organism to others and/or develop infection themselves. In addition, about a third of patients who carry C. difficilewill go on to develop infection within the next 6 months. The findings suggest that to curb the spread of C. difficile, attention must be paid to people who carry the organism but have not yet developed the disease.

ICT: What impact do these findings have on infection control protocols? Does it mean that C. difficiletesting might become routine for every patient entering a hospital?

Baron: While prospectively identifying carriers is not a recommended prevention strategy, it is considered a supplemental intervention in the [US Centers for Disease Control and Prevention’s] “Strategies to PreventClostridioides difficile Infection in Acute Care Facilities.” This study may give even more weight to this as a possible intervention. It is possible that more and more hospitals will consider identifying carriers in their highest risk populations to protect the individual patient and the patients around them from acquiring symptoms of the disease.

While this study focused on progression of disease from carrier state to symptomatic C. difficile, (we feel that many of our C. difficilecases likely started their hospital stay as carriers), we hope that this will actually help to fuel the conversation about enhanced infection control practices to prevent C. difficilespread. One question that our research could not answer was what to do next to prevent the progression of C. difficile.We do hope that our work on identification of carriers will encourage work on intensified Antibiotic Stewardship interventions, enhanced cleaning of all patient areas, and identification of at-risk patients as possible next steps.