782 - Clostridioides difficile environmental contamination in hospitalized patients with diarrhea: a pilot study

The ePoster content is available to users who are logged in.<br><br>Please log in and then come back here to use this button.

Presenting Author(s)

Bobby G. Warren

Lab Director
Duke University School of Medicine
Hillsborough, North Carolina
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

Nicholas A. Turner

Assistant Professor
Duke University Medical Center
Durham, North Carolina
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
RA

Rachel Addison

Clinical Research Coordinator
Duke Center for Antimicrobial Stewardship and Infection Prevention
Durham, NC
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AN

Alicia Nelson

Research Coordinator
Duke University School of Medicine
Durham, North Carolina
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SM

Samantha Marden

Research Technician
Duke University School of Medicine
Durham, North Carolina
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
IG

Isabella Gamez

High school research assistant
NCSSM
Charlotte, North Carolina
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
BS

Becky A. Smith

Medical Director Infection Prevention and Hospital Epidemiology, Associate Professor of Medicine
Duke University
durham, North Carolina
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
CP

Christopher R. Polage

Medical Director; Clinical Microbiology Laboratory
Duke University School of Medicine
Durham, North Carolina
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
David J. Weber

Professor of Medicine, Pediatrics and Epidemiology
University of North Carolina
Chapel Hill, NC
Disclosure: PDI (Consultant)
WR

William Rutala

Director, Statewide Program for Infection Control and Epidemiology Director, Hospital Epidemiology, Occupational Health and Safety Program
University of North Carolina
Chapel hill, NC
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Emily Sickbert-Bennett

Director of Hospital Epidemiology
UNC Medical Center
Chapel Hill, North Carolina
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
DA

Deverick J. Anderson

Professor
Duke Center for Antimicrobial Stewardship and Infection Prevention
Durham, North Carolina
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: The relative contribution of Clostridioides difficile colonization or infection in contamination of the hospital environment is poorly understood.

Methods: We performed a prospective cohort study of patients with diarrhea who were tested for C. difficile infection via PCR and enzyme immunoassay (EIA) to compare C. difficile environmental contamination by test result. Patients were stratified into one of three cohorts: PCR^-, PCR⁺/EIA⁺or PCR⁺/EIA^-. Environmental microbiological samples were taken within 24 hours of C. difficile cultures and again for two successive days for a total of three days. Patients were excluded if they had C. difficile infection in the past 6-weeks. Microbiological samples of surfaces were obtained with pre-moistened cellulose sponges from three locations (bathroom, adjacent to bed, and care areas) and processed using the stomacher technique. Ribotyping was completed on a subset of stool and environmental samples to measure concordance of isolates. CFU and recovery rates between arms were compared with a global ANOVA followed by pairwise comparisons using a Bonferroni adjustment.

Results: We enrolled 41 patients between November 2019 and March 2020. 7 patients were PCR⁺/EIA⁺, 8 were PCR⁺/EIA^-and 26 were PCR^- (Table 1). A total of 347 individual and 116 room samples were obtained. PCR⁺/EIA⁺ patient rooms had a higher average room burden (435.6 CFU (95%CI: 178.0-694.0)) compared to PCR⁺/EIA^- (83.5 (^-9.1-175.0), p< 0.01) and PCR^- rooms (17.1 (1.2-33.0), p< 0.01); PCR⁺/EIA^- and PCR^- rooms were similar (p=0.83). PCR⁺/EIA⁺ patient rooms had a higher recovery rate (61%) compared to PCR⁺/EIA^- (36%, p=0.64), although not statistically significant, and PCR^- rooms (16%, p< 0.01); PCR⁺/EIA^-had a similar recovery rate to PCR^- rooms (p=0.14) (Table 2). Of the rooms with both patient and environmental isolates, 79% of patient isolates had a concordant isolate recovered in the environment.Table 1

Table 2

Conclusion: The amount of environmental contamination of PCR⁺/EIA⁺patients was higher than both PCR⁺/EIA^- and PCR^- patients, however, the recovery rate of PCR⁺/EIA⁺ patients was similar to PCR⁺/EIA^- patients. Subsequent larger trials are needed to expand on this pilot data to determine the difference, if any, between environmental contamination levels of these patient populations.