REVIEW: CLINICAL AND SYSTEMATIC REVIEWS

Colonization With Toxinogenic C. difficile Upon Hospital Admission, and Risk of Infection: A Systematic Review and Meta-Analysis

Zacharioudakis, Ioannis M MD1; Zervou, Fainareti N MD1; Pliakos, Elina Eleftheria1; Ziakas, Panayiotis D MD, PhD1; Mylonakis, Eleftherios MD, PhD, FIDSA1

Author Information
American Journal of Gastroenterology 110(3):p 381-390, March 2015. | DOI: 10.1038/ajg.2015.22

Abstract

Objectives: 

It has been suggested that colonization withC.difficileprotects from infection. Nevertheless, the association between carriage of toxinogenic strains and ensuingC. difficileinfections (CDIs) has not been studied.

Methods: 

We searched PubMed and EMBASE databases up to 20 June 2014, using the term “difficile”. Our primary outcomes of interest included the prevalence of isolation of toxinogenicC. difficileor its toxins from asymptomatic patients on hospital admission through stool or rectal swab testing and the risk of ensuing infection among colonized and noncolonized patients. Data on previous hospitalization, antibiotic, and proton pump inhibitor (PPI) use and prior CDIs among colonized and noncolonized patients were also extracted.

Results: 

Nineteen out of 26,081 studies on 8,725 patients were included. The pooled prevalence of toxinogenicC. difficilecolonization was 8.1% (95% confidence interval (CI) 5.7–11.1%), with an increasing trend over time (P=0.003), and 10.0% (95% CI 7.1–13.4%) among North American studies. Patients colonized upon hospital admission had a 5.9 times higher risk of subsequent CDIs compared with noncolonized patients (relative risk (RR) 5.86; 95% CI 4.21–8.16). The risk of CDI for colonized patients was 21.8% (95% CI 7.9–40.1%), which was significantly higher than that of noncolonized patients (3.4%; 95% CI 1.5–6.0%;P=0.03), with an attributable risk of 18.4%. History of hospitalization during the previous 3 months was associated with a higher risk of colonization (RR 1.63; 95% CI 1.13–2.34), as opposed to previous antibiotic (RR 1.07; 95% CI 0.75–1.53) and PPI use (RR 1.44; 95% CI 0.94–2.23), as well as history of CDI (RR 1.45; 95% CI 0.66–3.18) that had no impact.

Conclusions: 

Over 8% of admitted patients are carriers of toxinogenicC. difficilewith an almost 6 times higher risk of infection. These findings update current knowledge regarding the contribution of colonization in CDI epidemiology and stress the importance of preventive measures toward colonized patients.

© The American College of Gastroenterology 2015. All Rights Reserved.

Full Text Access for Subscribers:

You can read the full text of this article if you:

Access through Ovid