Understanding and preventing Clostridium difficile transmission from asymptomatically colonized patients

艰难梭菌是美国医疗保健相关感染(HAI)的最常见原因，导致 每年至少有450,000例感染和29,000例相关死亡。艰难梭菌感染(CDI)预防现状 战略并没有降低CDI。这些策略的重点是预防艰难梭菌的传播。 有症状的CDI患者，而忽略更常见的无症状艰难梭菌携带者。 无症状艰难梭菌携带者污染医院环境，将艰难梭菌孢子转移到 医护人员手，并引入与后续CDI病例相关的压力。此外，最近 研究表明，至少30%至50%的新发CDI病例是由无症状的C. 艰难梭菌携带者。然而，针对无症状艰难梭菌携带者的干预措施的潜在影响是 没有得到充分的研究。预防艰难梭菌在住院患者中传播的一种这样的策略 患者将使用长袍和手套(接触预防措施)对无症状的患者进行移居 艰难梭菌。识别有接触的无症状携带者艰难梭菌传播的减少 预防措施将改变艰难梭菌预防的模式。我们假设病人 无症状地定植艰难梭菌对医院内的传播和接触很重要 对这些患者的预防措施将减少艰难梭菌在患者之间的传播。这项研究 设计是对从20家医院集群获得的储存样本进行回顾分析- 随机试验。目标1将评估所有与患者接触的人戴手套和穿长袍是否减少 艰难梭菌的获得和感染。目标2将评估殖民压力的相对重要性 艰难梭菌对艰难梭菌传播的影响，目标3将确定NAP-1/027菌株是否更多 比其他菌株更易传播。这种创新的方法将开发第一个随机试验水平的数据来 指导艰难梭菌感染预防，并将向科学宣传无症状个体的重要性 与NAP-1/027或其他艰难梭菌菌株共同定植。这项提议将超越最初的 目的1评估艰难梭菌定植压力、接触预防措施和NAP-1/027的关键问题 变速箱。

Clostridium difficile is the most common cause of healthcare-associated infections (HAIs) in the US, causing at least 450,000 infections and 29,000 associated deaths per year. Current C. difficile infection (CDI) prevention strategies have not decreased CDI. These strategies focus on preventing C. difficile transmission only from patients with symptomatic CDI, and ignore the much more common asymptomatic C. difficile carriers. Asymptomatic C. difficile carriers contaminate the hospital environment, transfer C. difficile spores to healthcare workers hands, and introduce strains associated with subsequent CDI cases. In addition, recent studies suggest at least 30% to 50% of new CDI cases are a result of transmission from asymptomatic C. difficile carriers. However, the potential impact of interventions directed at asymptomatic C. difficile carriers has not been adequately studied. One such strategy to prevent C. difficile transmission among hospitalized patients would be the use of gowns and gloves (contact precautions) for patients asymptomatically colonized with C. difficile. Identifying reductions in C. difficile transmission from asymptomatic carriers with contact precautions would change the paradigm of C. difficile prevention. We hypothesize that patients asymptomatically colonized with C. difficile are important for transmission in the hospital, and use of contact precautions for these patients will lead to decrease in patient-to-patient transmission of C. difficile. The study design is a retrospective analysis of stored specimens that were obtained from a 20 hospital cluster- randomized trial. Aim 1 will assess whether wearing gloves and gowns for all patient contact decreases acquisition of and infection with C. difficile. Aim 2 will assess the relative importance of colonization pressure with C. difficile on C. difficile transmission, and Aim 3 will determine if the NAP-1/027 strain is more transmissible than other strains. This innovative approach will develop the first randomized trial level data to guide C. difficile infection prevention and will inform science on the importance of individuals asymptomatically colonized with NAP-1/027 or other C. difficile strains. This proposal will go beyond the original cluster trial in Aim 1 to assess key questions of colonization pressure, contact precautions and NAP-1/027 on C. difficile transmission.