Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-23T06:45:16.271Z Has data issue: false hasContentIssue false
  • English
  • Français

An Evaluation of Food as a Potential Source for Clostridium difficile Acquisition in Hospitalized Patients

Published online by Cambridge University Press:  03 October 2016

Jennie H. Kwon ,
Cristina Lanzas ,
Kimberly A. Reske ,
Tiffany Hink ,
Sondra M. Seiler ,
Kerry M. Bommarito ,
Carey-Ann D. Burnham  and
Erik R. Dubberke
Jennie H. Kwon*
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
Cristina Lanzas
Affiliation:
Department of Population Health and Pathobiology, North Carolina State University, Raleigh, North Carolina
Kimberly A. Reske
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
Tiffany Hink
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
Sondra M. Seiler
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
Kerry M. Bommarito
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
Carey-Ann D. Burnham
Affiliation:
Departments of Pathology & Immunology, Molecular Microbiology, and Pediatrics, Washington University School of Medicine, St. Louis, Missouri
Erik R. Dubberke
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
*
Address correspondence to Jennie H. Kwon, MSCI, Washington University School of Medicine, Division of Infectious Diseases, 660 S Euclid Ave, Campus Box 8051, St. Louis, MO 63110 ([email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

To determine whether Clostridium difficile is present in the food of hospitalized patients and to estimate the risk of subsequent colonization associated with C. difficile in food.

METHODS

This was a prospective cohort study of inpatients at a university-affiliated tertiary care center, May 9, 2011–July 12, 2012. Enrolled patients submitted a portion of food from each meal. Patient stool specimens and/or rectal swabs were collected at enrollment, every 3 days thereafter, and at discharge, and were cultured for C. difficile. Clinical data were reviewed for evidence of infection due to C. difficile. A stochastic, discrete event model was developed to predict exposure to C. difficile from food, and the estimated number of new colonization events from food exposures per 1,000 admissions was determined.

RESULTS

A total of 149 patients were enrolled and 910 food specimens were obtained. Two food specimens from 2 patients were positive for C. difficile (0.2% of food samples; 1.3% of patients). Neither of the 2 patients was colonized at baseline with C. difficile. Discharge colonization status was available for 1 of the 2 patients and was negative. Neither was diagnosed with C. difficile infection while hospitalized or during the year before or after study enrollment. Stochastic modeling indicated contaminated hospital food would be responsible for less than 1 newly colonized patient per 1,000 hospital admissions.

CONCLUSIONS

The recovery of C. difficile from the food of hospitalized patients was rare. Modeling suggests hospital food is unlikely to be a source of C. difficile acquisition.

Infect Control Hosp Epidemiol 2016;1401–1407

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 12 , December 2016 , pp. 1401 - 1407
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Centers for Disease Control and Prevention (CDC). Antibiotic resistance threats in the United States, 2013. CDC website. http://www.cdc.gov/drugresistance/threat-report-2013/. Published 2014. Accessed January 9, 2016.Google Scholar
2. Lessa, FC, Mu, Y, Bamberg, WM, et al. Burden of Clostridium difficile infection in the United States. N Engl J Med 2015;372:825–834.Google Scholar
3. Kwon, JH, Olsen, MA, Dubberke, ER. The morbidity, mortality, and costs associated with Clostridium difficile infection. Infect Dis Clin North Am 2015;29:123–134.CrossRefGoogle ScholarPubMed
4. Walker, AS, Eyre, DW, Wyllie, DH, et al. Characterisation of Clostridium difficile hospital ward-based transmission using extensive epidemiological data and molecular typing. PLOS Med 2012;9:e1001172.Google Scholar
5. Grundmann, H, Barwolff, S, Tami, A, et al. How many infections are caused by patient-to-patient transmission in intensive care units? Crit Care Med 2005;33:946–951.Google Scholar
6. Bakri, MM, Brown, DJ, Butcher, JP, Sutherland, AD. Clostridium difficile in ready-to-eat salads, Scotland. Emerg Infect Dis 2009;15:817–818.Google Scholar
7. Eckert, C, Burghoffer, B, Barbut, F. Contamination of ready-to-eat raw vegetables with Clostridium difficile in France. J Med Microbiol 2013;62:1435–1438.CrossRefGoogle ScholarPubMed
8. Gould, LH, Limbago, B. Clostridium difficile in food and domestic animals: a new foodborne pathogen? Clin Infect Dis 2010;51:577–582.CrossRefGoogle ScholarPubMed
9. Jobstl, M, Heuberger, S, Indra, A, Nepf, R, Kofer, J, Wagner, M. Clostridium difficile in raw products of animal origin. Int J Food Microbiol 2010;138:172–175.Google Scholar
10. Lund, BM, Peck, MW. A possible route for foodborne transmission of Clostridium difficile? Foodborne Pathog Dis 2015;12:177–182.Google Scholar
11. Rodriguez-Palacios, A, Staempfli, HR, Duffield, T, Weese, JS. Clostridium difficile in retail ground meat, Canada. Emerg Infect Dis 2007;13:485–487.CrossRefGoogle ScholarPubMed
12. Rodriguez-Palacios, A, Reid-Smith, RJ, Staempfli, HR, et al. Possible seasonality of Clostridium difficile in retail meat, Canada. Emerg Infect Dis 2009;15:802–805.Google Scholar
13. Rodriguez, C, Korsak, N, Taminiau, B, et al. Clostridium difficile from food and surface samples in a Belgian nursing home: an unlikely source of contamination. Anaerobe 2015;32:87–89.Google Scholar
14. Songer, JG, Trinh, HT, Killgore, GE, Thompson, AD, McDonald, LC, Limbago, BM. Clostridium difficile in retail meat products, USA, 2007. Emerg Infect Dis 2009;15:819–821.Google Scholar
15. Von Abercron, SM, Karlsson, F, Wigh, GT, Wierup, M, Krovacek, K. Low occurrence of Clostridium difficile in retail ground meat in Sweden. J Food Prot 2009;72:1732–1734.Google Scholar
16. Weese, JS, Avery, BP, Rousseau, J, Reid-Smith, RJ. Detection and enumeration of Clostridium difficile spores in retail beef and pork. Appl Environ Microbiol 2009;75:5009–5011.Google Scholar
17. Weese, JS, Reid-Smith, RJ, Avery, BP, Rousseau, J. Detection and characterization of Clostridium difficile in retail chicken. Lett Appl Microbiol 2010;50:362–365.Google Scholar
18. Alasmari, F, Seiler, SM, Hink, T, Burnham, CA, Dubberke, ER. Prevalence and risk factors for asymptomatic Clostridium difficile carriage. Clin Infect Dis 2014;59:216–222.Google Scholar
19. Dubberke, ER, Reske, KA, Seiler, S, Hink, T, Kwon, JH, Burnham, CA. Risk factors for acquisition and loss of C. difficile colonization in hospitalized patients. Antimicrob Agents Chemother 2015;59:4533–4543.Google Scholar
20. Hink, T, Burnham, CA, Dubberke, ER. A systematic evaluation of methods to optimize culture-based recovery of Clostridium difficile from stool specimens. Anaerobe 2013;19:39–43.CrossRefGoogle ScholarPubMed
21. McFarland, LV, Coyle, MB, Kremer, WH, Stamm, WE. Rectal swab cultures for Clostridium difficile surveillance studies. J Clin Microbiol 1987;25:2241–2242.Google Scholar
22. Kundrapu, S, Sunkesula, VC, Jury, LA, Sethi, AK, Donskey, CJ. Utility of perirectal swab specimens for diagnosis of Clostridium difficile infection. Clin Infect Dis 2012;55:1527–1530.Google Scholar
23. Westblade, LF, Chamberland, RR, Maccannell, D, et al. Development and evaluation of a novel, semiautomated Clostridium difficile typing platform. J Clin Microbiol 2013;51:621–624.Google Scholar
24. Delignette-Muller, ML, Dutang, C. fitdistrplus: an R package for fitting distributions. J Stat Softw 2015;64.CrossRefGoogle Scholar
25. Gonzales-Barron, U, Butler, F. A comparison between the discrete Poisson-gamma and Poisson-lognormal distributions to characterise microbial counts in foods. Food Control 2011;22:1279–1286.Google Scholar
26. Villano, SA, Seiberling, M, Tatarowicz, W, Monnot-Chase, E, Gerding, DN. Evaluation of an oral suspension of VP20621, spores of nontoxigenic Clostridium difficile strain M3, in healthy subjects. Antimicrob Agents Chemother 2012;56:5224–5229.CrossRefGoogle ScholarPubMed
27. Hosmer, DW, Lemeshow, S, Sturdivant, RX. Applied Logistic Regression. 3rd ed. Hoboken, NJ: John Wiley & Sons; 2013.Google Scholar
28. Halekoh, U, Hojsgaard, S, Yan, J. The R package geepack for generalized estimating equations. J Stat Softw 2016;15.Google Scholar
29. Lanzas, C, Dubberke, ER. Effectiveness of screening hospital admissions to detect asymptomatic carriers of Clostridium difficile: a modeling evaluation. Infect Control Hosp Epidemiol 2014;35:1043–1050.CrossRefGoogle ScholarPubMed
30. Fekety, R, Kim, KH, Brown, D, Batts, DH, Cudmore, M, Silva, J Jr. Epidemiology of antibiotic-associated colitis; isolation of Clostridium difficile from the hospital environment. Am J Med 1981;70:906–908.Google Scholar
31. McFarland, LV, Mulligan, ME, Kwok, RY, Stamm, WE. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med 1989;320:204–210.CrossRefGoogle ScholarPubMed