SNFGE SNFGE
 
Thématique :
- Intestin/Nutrition/Troubles fonctionnels
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Docteur Pauline JOUET
 
 
Gastroenterology
  2017/04  
 
  2017 Apr;152(5):1031-1041.e2.  
  doi: 10.1053/j.gastro.2016.12.035.  
 
  Asymptomatic Carriers Contribute to Nosocomial Clostridium difficile Infection: A Cohort Study of 4508 Patients.  
 
  Blixt T, Gradel KO, Homann C, Seidelin JB, Schønning K, Lester A, Houlind J, Stangerup M, Gottlieb M, Knudsen JD  
  https://www.ncbi.nlm.nih.gov/pubmed/28063955  
 
 

Abstract

BACKGROUND & AIMS:

Nosocomial infections with Clostridium difficile present a considerable problem despite numerous attempts by health care workers to reduce risk of transmission. Asymptomatic carriers of C difficile can spread their infection to other patients. We investigated the effects of asymptomatic carriers on nosocomial C difficile infections.

METHODS:

We performed a population-based prospective cohort study at 2 university hospitals in Denmark, screening all patients for toxigenic C difficile in the intestine upon admittance, from October 1, 2012, to January 31, 2013. Screening results were blinded to patients, staff, and researchers. Patients were followed during their hospital stay by daily registration of wards and patient rooms. The primary outcomes were rate of C difficile infection in exposed and unexposed patients and factors associated with transmission.

RESULTS:

C difficile infection was detected in 2.6% of patients not exposed to carriers and in 4.6% of patients exposed to asymptomatic carriers at the ward level (odds ratio for infection if exposed to carrier, 1.79; 95% confidence interval, 1.16-2.76). Amount of exposure correlated with risk of C difficile infection, from 2.2% in the lowest quartile to 4.2% in the highest quartile of exposed patients (P = .026). Combining the load of exposure to carriers and length of stay seemed to have an additive effect on the risk of contracting C difficile.

CONCLUSIONS:

In a population-based prospective cohort study in Denmark, we found that asymptomatic carriers of toxigenic C difficile in hospitals increase risk of infection in other patients.

 
Question posée
 
Quel est l’impact des porteurs asymptomatiques de C Difficile producteurs de toxine sur le nombre de cas d’infections nosocomiales à C Difficile chez les patients hospitalisés ?
 
Question posée
 
Dans cette étude prospective danoise, un dépistage systématique a été effectué chez 4508 patients admis dans 2 Hôpitaux universitaires. En cas de contact avec un patient porteur asymptomatique, il y avait environ deux fois plus de risque de développer une infection à C Difficile (4,6% vs 2,6% en cas d’absence de contact).
 
Commentaires

Cette étude pourrait faire discuter l’intérêt d’un dépistage systématique des porteurs sains lorsqu’il existe une incidence élevée d’infection à C Difficile. 

 
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