ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2021
Genomic Determination of Relative Risks for Clostridioides difficile Infection From Asymptomatic Carriage in Intensive Care Unit Patients.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers.
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Who cites it
25 citing papers in PubMed.
- Optimized Surveillance Testing for ToxigenicmedRxiv : the preprint server for health sciences · 2026Article
- Evaluation of endoscopic processing on the potential forInfection prevention in practice · 2026Article
- Clostridioides difficile pathogenesis and control.Nature reviews. Microbiology · 2026Review
- Using electronic health records to assess the relationship between colonization pressure and nosocomial pathogen acquisition.Nature communications · 2026Article
- Genomic and clinical determinants of extraintestinalmedRxiv : the preprint server for health sciences · 2026Article
- Investigating in-hospital transmission ofJournal of the Association of Medical Microbiology and Infectious Disease Canada = Journal officiel de l'Association pour la microbiologie medicale et l'infectiologie Canada · 2025Article
- Antibiotic Use and the Risk of Hospital-Onset Clostridioides Difficile Infection.JAMA network open · 2025Article
- Longitudinal profiling of low-abundance strains in microbiomes with ChronoStrain.Nature microbiology · 2025Article
- Proceedings of the Clinical Microbiology Open 2024: artificial intelligence applications in clinical microbiology.Journal of clinical microbiology · 2025Article
- Heterogeneity of Clostridioides difficile asymptomatic colonization prevalence: a systematic review and meta-analysis.Gut pathogens · 2025Article
- Commensal-pathogen dynamics structure disease outcomes during Clostridioides difficile colonization.Cell host & microbe · 2025Article
- Comparison of rectal swabs and fecal samples for the detection ofMicrobiology spectrum · 2024Article
- Review
- Approaching pathogenicbioRxiv : the preprint server for biology · 2024Article
- Longitudinal genomic surveillance of carriage and transmission of Clostridioides difficile in an intensive care unit.Nature medicine · 2023Article
- Screening for Asymptomatic Clostridioides difficile Carriage Among Hospitalized Patients: A Narrative Review.Infectious diseases and therapy · 2023Review
- Evaluation of the microbiota-sparing properties of the anti-staphylococcal antibiotic afabicin.The Journal of antimicrobial chemotherapy · 2023Article
- Prospective Genomic Surveillance Reveals Cryptic MRSA Outbreaks with Local to International Origins among NICU Patients.Journal of clinical microbiology · 2023Article
- Prevalence and risk factors of toxigenicFrontiers in medicine · 2023Article
- Identification of TFPI as a receptor reveals recombination-driven receptor switching in Clostridioides difficile toxin B variants.Nature communications · 2022Article
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6 authors.
Funding
Abstract
backgroundClostridioides difficile infections (CDIs) are among the most prevalent hospital-associated infections (HAIs), particularly for intensive care unit (ICU) patients. The risks for developing active CDI from asymptomatic carriage of C. difficile are not well understood.
methodsWe identified asymptomatic C. difficile carriage among 1897 ICU patients using rectal swabs from an existing ICU vancomycin-resistant enterococci (VRE) surveillance program. C. difficile isolates from VRE swabs, and from C. difficile-positive stool samples, were genome sequenced. Spatial-temporal data from hospital records assessed genomically identified clusters for potential transmission events.
resultsGenomic analyses identified a diverse set of strains in infected patients and asymptomatic carriers. A total of 7.4% of ICU patients asymptomatically carried C. difficile; 69% of isolates carried an intact toxin locus. In contrast, 96% of C. difficile stool isolates were toxin encoding. CDI rates in asymptomatic carriers of toxin-encoding strains were 5.3% versus 0.57% in noncarriers. The relative risk for CDI with asymptomatic carriage of a toxin-encoding strain was 9.32 (95% confidence interval, 3.25-26.7). Genomic identification of clonal clusters supported analyses for asymptomatic transmission events, with spatial-temporal overlaps identified in 13 of 28 cases.
conclusionsOur studies provide the first genomically confirmed assessments of CDI relative risk from asymptomatic carriage of toxin-encoding strains and highlight the complex dynamics of asymptomatic transmission in ICUs. Asymptomatic carriers are an active reservoir of C. difficile in the nosocomial environment. C. difficile screening can be implemented within existing HAI surveillance programs and has the potential to support infection-control efforts against this pathogen.
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