A Clostridioides difficile Active Surveillance Program to identify Positive High-Risk Patients on Admit

AbstractBackground Clostridiodes difficile (CD) infection is associated with increased morbidity, mortality, and financial burden. Healthcare associated CD Infection (HA-CDI) is defined by the National Healthcare Safety Network (NHSN) as a positive CD test on or after hospital day three performed on an unformed stool. HA-CDI could be a true HAI versus community-acquired CDI (CA-CDI) or colonization. Identification of CD in high-risk patients on admission could reduce HA-CDI rates, reduce healthcare transmission, and possibly reduce unnecessary antibiotic use. Methods A prospective study was performed between July 1, 2022 and December 31, 2023. Patients with two of the following criteria were identified as high risk for colonization and tested for CD on admission: 1) readmission within 90 days; 2) admission from long term care facility; 3) chronic wounds present for >30 days; and 4) tracheostomy, or indwelling catheters. A stool specimen was collected prior to day three of hospital admission and tested for CD. Results There were 822 patients identified with two or more criteria. Testing was ordered and only 165 stool samples were collected. There were 42 (25%) positive and 123 (75%) negatives for CD. 21 specimens were cancelled by the lab for formed stool. 13 cancelled specimens were later tested in a research lab and 7 resulted positive. Conclusion Early identification of high-risk patients for CD colonization on admit could potentially reduce HA-CDI rates. CD status identification is helpful for environmental disinfection, hand hygiene, antibiotic selection, and isolation needs.