Hostname: page-component-6bf8c574d5-h6jzd Total loading time: 0.001 Render date: 2025-02-25T21:12:06.000Z Has data issue: false hasContentIssue false
  • English
  • Français

Household Transmission of Clostridium difficile to Family Members and Domestic Pets

Published online by Cambridge University Press:  08 August 2016

Vivian G. Loo ,
Paul Brassard  and
Mark A. Miller
Vivian G. Loo*
Affiliation:
McGill University Health Centre, McGill University, Montréal, Québec
Paul Brassard
Affiliation:
McGill University Health Centre, McGill University, Montréal, Québec
Mark A. Miller
Affiliation:
Jewish General Hospital, McGill University, Montréal, Québec, Canada
*
Address correspondence to Dr Vivian G. Loo, Division of Infectious Diseases and Department of Microbiology, McGill University Health Centre, 1001 Décarie Blvd. Room E05.1824, Montréal, Québec, Canada, H4A 3J1 ([email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

To determine the risk of Clostridium difficile transmission from index cases with C. difficile infection (CDI) to their household contacts and domestic pets.

DESIGN

A prospective study from April 2011 to June 2013.

SETTING

Patients with CDI from Canadian tertiary care centers.

PARTICIPANTS

Patients with CDI, their household human contacts, and pets.

METHODS

Epidemiologic information and stool or rectal swabs were collected from participants at enrollment and monthly for up to 4 months. Pulsed-field gel electrophoresis (PFGE) was performed on C. difficile isolates. Probable transmission was defined as the conversion of a C. difficile culture–negative contact to C. difficile culture–positive contact with a PFGE pattern indistinguishable or closely related to the index case. Possible transmission was defined as a contact with a positive C. difficile culture at baseline with a strain indistinguishable or closely related to the index case.

RESULTS

A total of 51 patients with CDI participated in this study; 67 human contacts and 15 pet contacts were included. Overall, 9 human contacts (13.4%) were C. difficile culture positive; 1 contact (1.5%) developed CDI; and 8 contacts were asymptomatic. Of 67 human contacts, probable transmission occurred in 1 human contact (1.5%) and possible transmission occurred in 5 human contacts (7.5%). Of 15 pet contacts, probable transmission occurred in 3 (20%) and possible transmission occurred in 1 (6.7%).

CONCLUSIONS

There was a high proportion of C. difficile culture positivity at 13.4% among human contacts and asymptomatic carriage of domestic pets reached 26.7%. These results suggest that household transmission of C. difficile may be a source of community-associated cases.

Infect Control Hosp Epidemiol 2016;1–7

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 11 , November 2016 , pp. 1342 - 1348
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. McDonald, LC, Killgore, GE, Thompson, A, et al. An epidemic, toxin gene-variant strain of Clostridium difficile . N Engl J Med 2005;353:2433–2441.CrossRefGoogle ScholarPubMed
2. Loo, VG, Poirier, L, Miller, MA, et al. A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med 2005;353:2442–2449.CrossRefGoogle ScholarPubMed
3. Kuijper, EJ, Coignard, B, Tull, P, et al. Emergence of Clostridium difficile-associated disease in North America and Europe. Clin Microbiol Infect 2006;12(Suppl 6):2–18.Google Scholar
4. 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.CrossRefGoogle ScholarPubMed
5. Chitnis, AS, Holzbauer, SM, Belflower, RM, et al. Epidemiology of community-associated Clostridium difficile infection, 2009 through 2011. JAMA Intern Med 2013;173:1359–1367.Google Scholar
6. Lessa, FC. Community-associated Clostridium difficile infection: how real is it? Anaerobe 2013;24:121–123.Google Scholar
7. Dial, S, Delaney, JAC, Schneider, V, Suissa, S. Proton pump inhibitor use and risk of community-acquired Clostridium difficile-associated disease defined by prescription for oral vancomycin therapy. CMAJ 2006;175:745–748.Google Scholar
8. Noren, T, Akerlund, T, Back, E, et al. Molecular epidemiology of hospital-associated and community-acquired Clostridium difficile infection in a Swedish county. J Clin Microbiol 2004;42:3635–3643.Google Scholar
9. McFarland, LV, Mulligan, ME, Kwok, RYY, Stamm, WE. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med 1989;320:204–210.CrossRefGoogle ScholarPubMed
10. Samore, MH, DeGirolami, PC, Tlucko, A, Lichtenberg, DA, Melvin, ZA, Karchmer, AW. Clostridium difficile colonization and diarrhea at a tertiary care hospital. Clin Infect Dis 1994;18:181–187.Google Scholar
11. Wendt, JM, Cohen, JA, Mu, Y, et al. Clostridium difficile infection among children across diverse US geographic locations. Pediatrics 2014;133:651–658.Google Scholar
12. Pant, C, Deshpande, A, Altaf, MA, Minocha, A, Sferra, TJ. Clostridium difficile infection in children: a comprehensive review. Curr Med Res Opin 2013;29:967–984.Google Scholar
13. Kociolek, LK, Patel, SJ, Shulman, ST, Gerding, DN. Molecular epidemiology of Clostridium difficile infections in children: a retrospective cohort study. Infect Control Hosp Epidemiol 2015;36:445–451.CrossRefGoogle ScholarPubMed
14. Borriello, SP, Honour, P, Turner, T, Barclay, F. Household pets as a potential reservoir for Clostridium difficile infection. J Clin Pathol 1983;36:84–87.Google Scholar
15. Baishnab, D, Banfield, KR, Jones, K, Scott, KS, Weightman, NC, Kerr, KG. Clostridium difficile infection: it’s a family affair. Infect Control Hosp Epidemiol 2013;34:442–443.Google Scholar
16. Kundrapu, S, Sunkesula, VCK, Jury, LA, Sethi, AK, Donskey, CJ. Utility of perirectal swab specimens for diagnosis of Clostridium difficile infection. Clin Infect Dis 2012;55:1527–1530.CrossRefGoogle ScholarPubMed
17. Clabots, CR, Gerding, SJ, Olson, MM, Peterson, LR, Gerding, DN. Detection of asymptomatic Clostridium difficile carriage by an alcohol shock procedure. J Clin Microbiol 1989;27:2386–2387.Google Scholar
18. Aspinall, ST, Hutchinson, DN. New selective medium for isolating Clostridium difficile from faeces. J Clin Pathol 1992;45:812–814.CrossRefGoogle ScholarPubMed
19. Fawley, WN, Wilcox, MH. Pulsed-field gel electrophoresis can yield DNA fingerprints of degradation-susceptible Clostridium difficile strains. J Clin Microbiol 2002;40:3546–3547.Google Scholar
20. Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.CrossRefGoogle ScholarPubMed
21. Rousseau, C, Poilane, I, De Pontual, L, Maherault, A-C, Le Monnier, A, Collignon, A. Clostridium difficile carriage in healthy infants in the community: a potential reservoir for pathogenic strains. Clin Infect Dis 2012;55:1209–1215.Google Scholar
22. O’Neill, G, Adams, JE, Bowman, RA, Riley, TV. A molecular characterization of Clostridium difficile isolates from humans, animals and their environments. Epidemiol Infect 1993;111:257–264.Google Scholar
23. Weese, JS, Finley, R, Reid-Smith, RR, Janecko, N, Rousseau, J. Evaluation of Clostridium difficile in dogs and the household environment. Epidemiol Infect 2010;138:1100–1104.CrossRefGoogle ScholarPubMed
24. Shaughnessy, MK, Bobr, A, Kuskowski, MA, et al. Environmental contamination in households of patients with recurrent Clostridium difficile infection. Appl Environ Microbiol 2016;82:2686–2692.Google Scholar
25. Pepin, J, Gonzales, M, Valiquette, L. Risk of secondary cases of Clostridium difficile infection among household contacts of index cases. J Infect 2012;64:387–390.Google Scholar
26. Salipante, SJ, SenGupta, DJ, Cummings, LA, Land, TA, Hoogestraat, DR, Cookson, BT. Application of whole-genome sequencing for bacterial strain typing in molecular epidemiology. J Clin Microbiol 2015;53:1072–1079.Google Scholar