Asymptomatic Clostridium difficile colonization as a reservoir for Clostridium difficile infection

Abstract

Clostridium difficile (CD) infection (CDI) is the leading cause of healthcare associated diarrhea despite intense hospital infection prevention programs. A substantial proportion of the population is asymptomatically colonized with CD, and evidence is mounting that these individuals serve as a reservoir for CDI. The purpose of this review is to discuss the mechanisms by which individuals may harbor toxigenic CD but remain asymptomatic, the evidence that asymptomatically colonized individuals serve as a source of CDI, and the implications of this potential CD reservoir for healthcare infection prevention.

Keywords::

• asymptomatic carriage
• Clostridium difficile
• Clostridium difficile infection
• colonization
• epidemiology
• molecular epidemiology

Financial & competing interests disclosure

LH Harrison has received research funding, through the University of Pittsburgh, from ViroPharma. The authors have no other relevant affiliations or entity with a financial interest in or financial conflict with the subject matter or material discussed in this manuscript.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Despite intense infection prevention efforts, Clostridium difficile (CD) remains a formidable hospital-associated pathogen.

• Substantial proportions of hospitalized patients and healthy individuals are asymptomatically colonized with CD.

• Strong evidence suggests that CD-colonized individuals are a reservoir for CD infection.

• Integration of CD-colonized individuals into hospital infection prevention programs could substantially reduce the incidence of CDI in hospital settings.