The usual assumption about how Clostridium difficile spreads has now been challenged since only a few cases could be located to the patients sharing the same ward. The traditional and the most common perception that C difficile is acquired by contact with the patients who are infected with the bacterium received a hard blow as the new data contradicts the same.
A. Sarah Walker, PhD, from the National Institute for Health Research Oxford Biomedical Research Centre, JohnRadcliffHospital, Oxford, and the Medical Research Council Clinical Trials Unit, London, United Kingdomsaid, “A better understanding of other routes of transmission and reservoirs is needed to determine what other types of control interventions are required to reduce the spread of C. difficile.”
Using both enzyme immunoassay and culture, 29,299 stool samples from 14,858 patients suffering from regular diarrhea at Oxford Radcliff Hospitals were tested and the test revealed that 1282 (4.4%) were positive for the C difficile bacterium. However, when the bacteria was genotyped, it was found that only 23% of patients shared the same type of bacterium as a patient infected in the same ward and 69 types of C. difficile were identified. 465 (66%) of the 705 cases could not be linked to a donor when, for possible transmission a period of 8 weeks was allowed. Also with fewer cases linked in general surgery, cases with a credible donor was highest in renal/transplant, hematology/oncology and acute/elderly medicine. When the incubation period was increased and then decreased later, the proportion with credible ward based donors also increased and decreased respectively.
However, the window of transmission needs to be answered if the patients are not getting infected from each other and it is suggested that 7% to 26% of adult inpatients may be asymptomatic carriers. Another cause of transmission includes the movement of patients about the hospital or through equipment and healthcare workers caring for patients. The possibility of inter-ward transmission can be a limitation of the study as pointed out by Stephan Harbarth, MD, from the Infection Control Program, University of Geneva Hospitals andMedicalSchoolinSwitzerland, and Matthew H. Samore, MD, from theUniversityofUtah,Salt Lake City. Besides that, some undiagnosed patients with C difficile might have been overlooked by the researchers since enzyme immunoassay testing is not very case sensitive and also this research does not record antibiotic exposure, thus limiting its practical implications.