Clostridium difficile exposure as an insidious source of infection in healthcare settings: an epidemiological model

dc.contributor.authorYakob, Laith
dc.contributor.authorRiley, Thomas
dc.contributor.authorPaterson, D L
dc.contributor.authorClements, Archie
dc.date.accessioned2018-11-29T22:55:10Z
dc.date.available2018-11-29T22:55:10Z
dc.date.issued2013
dc.date.updated2018-11-29T08:04:52Z
dc.description.abstractBackground: Clostridium difficile is the leading cause of infectious diarrhea in hospitalized patients. Its epidemiology has shifted in recent years from almost exclusively infecting elderly patients in whom the gut microbiota has been disturbed by antimicrobials, to now also infecting individuals of all age groups with no recent antimicrobial use.Methods: A stochastic mathematical model was constructed to simulate the modern epidemiology of C. difficile in a healthcare setting, and, to compare the efficacies of interventions.Results: Both the rate of colonization and the incidence of symptomatic disease in hospital inpatients were insensitive to antimicrobial stewardship and to the prescription of probiotics to expedite healthy gut microbiota recovery, suggesting these to be ineffective interventions to limit transmission. Comparatively, improving hygiene and sanitation and reducing average length of stay more effectively reduced infection rates. Although the majority of new colonization events are a result of within-hospital ward exposure, simulations demonstrate the importance of imported cases with new admissions.Conclusions: By analyzing a wide range of screening sensitivities, we identify a previously ignored source of pathogen importation: although capturing all asymptomatic as well as symptomatic introductions, individuals who are exposed but not yet colonized will be missed by even a perfectly sensitive screen on admission. Empirical studies to measure the duration of this latent period of infection will be critical to assessing C. difficile control strategies. Moreover, identifying the extent to which the exposed category of individual contributes to pathogen importation should be explicitly considered for all infections relevant to healthcare settings.
dc.format.mimetypeapplication/pdfen_AU
dc.identifier.issn1471-2334
dc.identifier.urihttp://hdl.handle.net/1885/153071
dc.publisherBioMed Central
dc.sourceBMC Infectious Diseases
dc.subjectKeywords: article; bacterial colonization; Clostridium difficile infection; comorbidity; controlled study; disease transmission; environmental exposure; epidemiological data; health care facility; health care personnel; human; hygiene; immune status; infectious dia
dc.titleClostridium difficile exposure as an insidious source of infection in healthcare settings: an epidemiological model
dc.typeJournal article
dcterms.accessRightsOpen Accessen_AU
local.bibliographicCitation.issue1
local.contributor.affiliationYakob, Laith, The University of Queensland
local.contributor.affiliationRiley, Thomas, University of Western Australia
local.contributor.affiliationPaterson, D L, University of Queensland
local.contributor.affiliationClements, Archie, College of Health and Medicine, ANU
local.contributor.authoremailu5611518@anu.edu.au
local.contributor.authoruidClements, Archie, u5611518
local.description.notesImported from ARIES
local.identifier.absfor111706 - Epidemiology
local.identifier.ariespublicationu5427758xPUB103
local.identifier.citationvolume13
local.identifier.doi10.1186/1471-2334-13-376
local.identifier.scopusID2-s2.0-84881529136
local.identifier.thomsonID000323175400001
local.identifier.uidSubmittedByu5427758
local.type.statusPublished Version

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