Environmental shedding of toxigenic Clostridioides difficile by asymptomatic carriers: A prospective observational study

M. Gilboa, E. Houri-Levi, C. Cohen, I. Tal, C. Rubin, O. Feld-Simon, A. Brom, Y. Eden-Friedman, S. Segal, G. Rahav, G. Regev-Yochay, Howard Amital, Sharon Beni, Ilan Ben-Zvi, Natasha Blausov, Adi Brom, Carmit Cohen, Olga Feld-Simon, Ronen Fluss, Mayan GilboaYehudit Eden-Friedman, Shiraz Halevy, Esther Houri-Levi, Amit Hupert, Amnah Jbarien, Naty Keller, Avshalom Leibowitz, Haim Mayan, Leonid Maizels, Eyal Meltzer, Nani Pinas-Zade, Galia Rahav, Shir Raibman-Spector, Gili Regev-Yochay (PI), Marina Romiantsev, Dalit Shachar, Kassem Sharif, Gadi Segal, Shoshi Segal, Amitai Segev, Gill Smollan, Shmuel Stienlauf, Ilana Tal, Hagit Yonath, Tal Zilberman-Daniels, Eyal Zimlichman

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19 Scopus citations


Objectives: The aim was to compare the burden of environmental shedding of toxigenic Clostridioides difficile among asymptomatic carriers, C. difficile-infected (CDI) patients and non-carriers in an inpatient non-epidemic setting. Methods: C. difficile carriage was determined by positive toxin-B PCR from rectal swabs of asymptomatic patients. Active CDI was defined as a positive two-step enzyme immunoassay/polymerase chain reaction (EIA/PCR) test in patients with more than three unformed stools/24 hr. C. difficile environmental contamination was assessed by obtaining specimens from ten sites in the patients' rooms. Toxigenic strains were identified by PCR. We created a contamination scale to define the overall level of room contamination that ranged from clean to heavy contamination. Results: One hundred and seventeen rooms were screened: 70 rooms inhabited by C. difficile carriers, 30 rooms by active CDI patients and 17 rooms by non C. difficile -carriers (control). In the carrier rooms 29 (41%) had more than residual contamination, from which 17 (24%) were heavily contaminated. In the CDI rooms 12 (40%) had more than residual contamination from which three (10%) were heavily contaminated, while in the control rooms, one room (6%) had more than residual contamination and none were heavily contaminated. In a multivariate analysis, the contamination score of rooms inhabited by carriers did not differ from rooms of CDI patients, yet both were significantly more contaminated than those of non-carriers odd ratio 12.23 and 11.16 (95% confidence interval 1.5–99.96 p 0.0195, and 1.19–104.49 p 0.035), respectively. Discussion: Here we show that the rooms of C. difficile carriers are as contaminated as those of patients with active CDI and significantly more than those of non-carriers.

Original languageEnglish
Pages (from-to)1052-1057
Number of pages6
JournalClinical Microbiology and Infection
Issue number8
StatePublished - Aug 2020


FundersFunder number
Ministry of Health, State of Israel


    • Asymptomatic carriers
    • Clostridioides difficile
    • Environmental contamination
    • Infection control
    • Isolation


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