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• W2108446058 abstract "Clostridium difficile is considered a leading cause of hospital-acquired diarrhea. To evaluate the prevalence of asymptomatic C difficile stool carriage among hospital staff, we tested stool samples from 112 volunteers for toxigenic C difficile. Usually, there is no significant risk for healthy adults in acquiring a C difficile infection (CDI) because their mature colonic bacterial flora will resist colonization with C difficile.1Reeves A.E. Theriot C.M. Bergin I.L. Huffnagle G.B. Schloss P.D. Young V.B. The interplay between microbiome dynamics and pathogen dynamics in a murine model of Clostridium difficile infection.Gut Microbes. 2011; 2: 145-158Crossref PubMed Scopus (187) Google Scholar CDI in humans is generally linked to procedures that alter the normal enteric flora (antibiotic treatment or antineoplastic chemotherapy). Several outbreaks via a contaminated hospital environment or the contaminated hands of hospital personnel have shown the risk of nosocomial acquistion of CDI.2McFarland L.V. Mulligan M.E. Kwok R.Y. Stamm W.E. Nosocomial Acquisition of Clostridium difficile infection.N Engl J Med. 1989; 320: 204-210Crossref PubMed Scopus (1141) Google Scholar We chose to study the prevalence of C difficile stool carriage in asymptomatic hospital staff in Austria to assess the risk of healthy hospital staff acquiring C difficile. Probands were restricted to persons without a history of diarrhea or antibiotic usage for 3 months among hospital staff prior to testing (Table 1). Stool samples (n = 112) were gained from April to July 2010 at a 1,200 bed tertiary care university hospital. The male to female ratio was 1:5.3 (Table 2). The study was approved by the local ethics committee. Microbiological diagnostics were performed by direct plating onto C difficile selective agar (cycloserine/cefoxitin agar; bioMérieux, Marcy l'Etoile, France) plus broth enrichment as described elsewhere.3Mac Faddin J.D. Media for isolation-cultivation-identification-maintenance of medical bacteria. Vol. 1. Williams & Wilkins, Baltimore [MD]1985Google ScholarTable 1Study group by affiliationAbsolute number% Of totalGastroenterology98.0Hematology and oncology1916.9Pediatrics2118.8General surgery1916.9Pediatric surgery108.9Vascular surgery119.8Medical school students1210.7Anaesthesiology76.3Intensive care unit10.9Physical therapy32.7Total112100 Open table in a new tab Table 2Study group by occupationStudy groupAge, yrSexAbsolute number% Of totalMedianRangeFemaleClerical staff21.83529-41100%Janitorial staff32.75351-56100%Physiotherapists32.73230-34100%Nurses7768.83921-5694%Medical school Students119.82422-2782%Physicians1614.34728-6244%Total1121003921-6286% Open table in a new tab One hundred twelve healthy and asymptomatic staff members from 9 departments and the medical school were screened for C difficile. All stool samples tested negative by primary inoculation of the selective plate. Enough material (≥1 g) to perform testing by broth enrichment technique was available for 45 of the 112 samples (40.2%). Broth enrichment technique yielded negative results for all stool samples tested. Also, 67 stool samples provided by administrative staff of a major Austrian groceries chain proved negative when tested (parallel to our study) using both methods (data not shown). In medical literature, it is widely supposed that C difficile stool carriage is frequently found in healthy adults, including hospital staff. Van Nood et al reported 13% of asymptomatic hospital staff (75% of these being physicians) in The Netherlands to show C difficile stool carriage.4van Nood E. van Dijk K. Hegeman Z. Speelman P. Visser C.E. Asymptomatic carriage of Clostridium difficile among HCWs: do we disregard the doctor?.Infect Control Hosp Epidemiol. 2009; 30: 924-925Crossref PubMed Scopus (12) Google Scholar Kato et al demonstrated that 4.3% of hospital personnel in Japan carried C difficile.5Kato H. Kita H. Karasawa T. Maegawa T. Koino Y. Takakuwa H. et al.Colonisation and transmission of Clostridium difficile in healthy individuals examined by PCR ribotyping and pulsed-field gel electrophoresis.J Med Microbiol. 2001; 50: 720-727Crossref PubMed Scopus (104) Google Scholar Our finding of absence of fecal carriage in Austrian hospital staff was surprising but in accordance with results reported by Carmeli et al, who showed absence of intestinal carriage of C difficile among 55 hospital staff in Israel.6Carmeli Y. Venkataraman L. DeGirolami P.C. Lichtenberg D.A. Karchmer A.W. Samore M.H. Stool colonization of healthcare workers with selected resistant bacteria.Infect Control Hosp Epidemiol. 1998; 19: 38-40Crossref PubMed Scopus (22) Google Scholar In addition, our study has the limitation of a relatively low sample size, but it guarantees an upper confidence bound of 2.6% for zero findings (95% confidence level). Because specimens from symptomatic patients—tested for C difficile at the same time by the same method (direct plating)—yielded toxigenic C difficile, we abnegate the occurrence of false-negative results.7Hell M. Permoser M. Chmelizek G. Kern J.M. Maass M. Huhulescu S. et al.Clostridium difficile infection: monoclonal or polyclonal genesis?.Infection. 2011; 39: 461-465Crossref PubMed Scopus (13) Google Scholar Similar discrepant findings have previously been reported for occurrence of C difficile in food (ground meat): whereas Rodriguez-Palacios et al in Canada found 20% of tested samples positive for C difficile,8Rodriguez-Palacios A. Staempfli H.R. Duffield T. Weese J.S. Clostridium difficile in retail ground meat, Canada.Emerg Infect Dis. 2007; 13: 485-487Crossref PubMed Scopus (222) Google Scholar Jöbstl et al reported a contamination rate of only 3% C difficile in ground meat in Austria.9Jöbstl M. Heuberger S. Indra A. Nepf R. Köfer J. Wagner M. Clostridium difficile in raw products of animal origin.Int J Food Microbiol. 2010; 138: 172-175Crossref PubMed Scopus (73) Google Scholar This different contamination rate of ground meat might be just one of many factors explaining the discrepant results concerning C difficile carriage in healthy adults from different countries. In Austria, C difficile is the most frequently diagnosed bacterial pathogen in patients with community-acquired gastroenteritis, accounting for 18.7% of positive results, second only to norovirus (36.0%).10Huhulescu S. Kiss R. Brettlecker M. Cerny R.J. Hess C. Wewalka G. et al.Etiology of acute gastroenteritis in three sentinel general practices, Austria 2007.Infection. 2009; 37: 103-108Crossref PubMed Scopus (63) Google Scholar Our finding of absence of fecal carriage in healthy hospital staff and in healthy administrative staff of a food trade company underlines the diagnostic relevance of a positive stool result in patients with acute community acquired gastroenteritis. It also indicates that there is only low risk for healthy hospital staff for acquiring C difficile. Our findings also emphasize the diagnostic relevance of C difficile detection in symptomatic health care workers with diarrhea. We would like to thank Professor Christian Datz for providing us with stool samples of the non-hospital-staff and also Dr. David Schein for his support in proofreading." @default.
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• W2108446058 title "Absence of Clostridium difficile in asymptomatic hospital staff" @default.
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