AUTHOR=Jolivet Sarah , Couturier Jeanne , Grohs Patrick , Vilfaillot Aurélie , Zahar Jean-Ralph , Frange Pierre , Casetta Anne , Moulin Véronique , Lawrence Christine , Baune Patricia , Bourgeois Cléo , Bouffier Axel , Laussucq Claudine , Sienzonit Lydia , Picard Simon , Podglajen Isabelle , Kassis-Chikhani Najiby , Barbut Frédéric 

TITLE=Prevalence and risk factors of toxigenic Clostridioides difficile asymptomatic carriage in 11 French hospitals

JOURNAL=Frontiers in Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2023.1221363

DOI=10.3389/fmed.2023.1221363

ISSN=2296-858X

ABSTRACT=Clostridioides difficile infection (CDI) incidence has increased over the last twenty years. Studies suggest that asymptomatic carriers may be an important reservoir of C. difficile in healthcare settings. We conducted a point prevalence study to estimate the toxigenic C. difficile asymptomatic carriage rate and the associated risk factors in patients > 3 years old. Between 16/09/2019 and 15/01/2020, all patients hospitalized in 11 healthcare facilities in the Paris urban area were included in the study. They were screened on the day of the survey for toxigenic C. difficile carriage by rectal swab and interviewed. Isolates were characterized by PCR ribotyping and multiplex PCR targeting toxin genes. A logistic regression model was used to determine the risk factors associated with toxigenic C. difficile asymptomatic carriage using uni-and multivariate analysis in the subpopulation of patients > 3 years old. During the study period, 2389 patients were included and screened. The median age was 62 years (interquartile range 35-78 years) and 1153 were male (48.3%). Nineteen patients had a previous CDI (0.9%). Overall, 185/2389 patients were positive for C. difficile (7.7%), including 93 toxigenic strains (3.9%): 77 (82.8%) were asymptomatic (prevalence 3.2%) whereas 12 (12.9%) were diarrheic. Prevalences of toxigenic C. difficile were 3.5% in patients > 3 years old and 7.0% in ≤ 3 years old subjects, respectively. Toxigenic strains mainly belonged to PCR ribotypes 106 (n=14, 15.0%), 014 (n=12, 12.9%), and 020 (n=10, 10.8%). Among toxigenic strains, 6 (6.4%) produced the binary toxin. In multivariate analysis, two factors were positively associated with toxigenic C. difficile asymptomatic carriage in patients > 3 years old: multidrug-resistant organisms co-carriage (adjusted Odd Ratio [aOR] 2.3, CI 95% 1.2-4.7, p=0.02) and previous CDI (aOR 5.8, CI 95% 1.2-28.6, p=0.03). Conversely, consumption of raw milk products were associated with reduced risk of toxigenic C. difficile colonization had a significant protective effect (aOR 0.5, CI 95% 0.2-0.9, p=0.01). We showed that there was a low prevalence of asymptomatic toxigenic C. difficile carriage in hospitalized patients. Consumption of raw milk prevents toxigenic C. difficile colonization, probably due to the barrier effect of milk-associated bacteria.