Research highlights the hidden spread of ICU C Diff

new study Researchers at the University of Utah suggest that the most common healthcare-related infectious diseases (HAIS) are more prevalent in intensive care units (ICUs) than previously understood.

Survey results published last week Jama Network Open, Based on genome analysis of Clostridium difficile Isolates collected in 2018 from two ICUs in Utah. Researchers aimed to quantify rates C difficulty It spreads across two ICUs and explains the transmission dynamics. C difficulty It causes severe diarrhea and is the leading cause of HAI worldwide, accounting for 223,000 hospitalizations and 12,800 deaths in the United States each year.

On the other hand, most genomic studies C difficulty Analyse a sample of communicating patients in hospital. This study also included sampling of the hands and hospital environments of healthcare providers (HCPs) to understand how pathogens move between patients and hospital surfaces. What the researchers found was that almost 8% of hospitalized patients had it C difficulty It was genetically associated with another patient, and the movement of the pathogen was more than three times higher than if it had been dependent solely on patient sampling.

“A lot is happening under the hood that we haven't seen,” said Michael Rubin, MD, PhD, an epidemiologist and infectious disease expert at the University of Utah. press release.

Enhanced sampling captures more C DIFF transmissions

In the 13-week study, the researchers collected samples daily from three patient body parts, three surfaces of the patient's room (the patient's touch surface, HCP touch surface, and toilet surface), and HCP hands or gloves that cared for the patient. Whole genome sequencing (WGS) was then performed both toxinous and nontoxinous. C difficulty Isolates for identifying permeation clusters (defined as isolates with no more than two single nucleotide variants between them). Non-toxic C difficulty Strains are not usually associated with infection and are not included in most surveillance studies.

A total of 7,000 samples were collected at 278 unique ICU admissions over the course of the study, with 177 patients agreeing to body site sampling. From these samples, the researchers recovered 178 C difficulty Isolates-46 from the patient's body site, 87 from the patient's room, 1 from the shared environment surface, and 44 from the HCP hand.

There is a lot we haven't seen under the hood.

WGS analysis identified seven transmission clusters, including 22 (7.7%) of the 287 residents. Of the clusters, isolates from two different resident body sites are included, suggesting patient-to-patient transmission, while the other two include environmental or HCP hand isolates and patient isolates. The remaining three included isolates from the environmental surface from multiple residents' stays. Only two of the 22 clustered residents were associated with consecutive residents in the same room.

“Importantly, five of these transmission clusters (71.4%) would have been overlooked without the expansion of environmental surfaces and HCP hand sampling.

The author points out most of the C difficulty The isolates were identified as non-toxin and both were found to have only two patients in the same hospital. C difficulty infection. However, the fact that many of the transmission clusters contained isolates from the environmental surface and HCP hands suggests C difficulty ICU transmission has been underestimated in previous studies and may indicate lapse of infection prevention and control that allows for toxin spread it's difficult.

“What I hope from this paper is for healthcare providers to place more emphasis on infection prevention measures and adhere to them whenever possible,” Rubin said.