C Difficile Contamination Increases Following CDI Infusions

Claudia P. Schroeder, PhD, PharmD

New research quantifies the presence of Clostridioides difficile in an outpatient hospital care setting following infusions for patients with Clostridioides difficile infections (CDI).

A team, led by Claudia P. Schroeder, PhD, PharmD, Healix Infusion Therapy, identified C difficile contamination in the environment of patients with CDI, as well as non-CDI patients, and evaluated the effectiveness of standard cleaning.

Outpatient Infusion Centers

Patients with C difficile infections treated at outpatient infusion centers can be at a heightened risk for spore transmission. And while community transmission of C difficile has been documented, there is not much data on environmental contamination of C difficile in the outpatient healthcare setting.

“Outpatient infusion centers have been increasingly used for provision of intravenous drug therapy to patients with a variety of infectious diseases including those with a history of CDI,” the authors wrote. “Nevertheless, concerns remain that CDI patients who receive treatment at an OIC can shed C. difficile spores into the environment leading to contamination of infusion chairs, medical equipment and surrounding areas, potentially enabling horizontal spore transmission to other at-risk patients or healthcare workers.”

Sampling C Difficile

In the multicenter, non-conventional study, the investigators looked at 8 outpatient infusion centers in geographically diverse areas between October 2019 and December 2020 and collected environmental samples at baseline, following infusions, and after cleaning CDI and non-CDI areas. There were a total of 6 sampling days per facility permitted to maintain equal distribution.

Cleaning was performed with hypochlorite products for CDI and non-hypochlorite products for non-CDI.

The investigators also cultured samples for toxigenic C difficile and strain typed via fluorescent PCR ribotyping and whole-genome sequencing.

Contamination

The C difficile contamination rate was 7.9% (n = 156). This was split between 8.1% in patients and 5.6% in non-patient care areas.

In the CDI areas, the contamination was 5.9% at baseline, rose to 15.0% after infusion, and was brought back down to 6.2% following cleaning (P = 0.004). The differences in the non-CDI care areas were not as drastic. Contamination at baseline was 9.5%, actually decreased to 7.6% after infusion, and was further reduced to 4.3% after cleaning.

The difference in C difficile-positive samples following infusion was significant for CDI compared to non-CDI (15.0% vs. 7.6%, P = 0.004).

The investigators also looked at contamination on specific surfaces. Contamination was 11.5% on floors, 7.9% on infusion chairs, and 3.8% on equipment (P = 0.001).

The most frequent ribotypes were F014-020 (42.6%), F106 (15.6%), F255 (6.1%), F001 (5.2%) and F027 (3.5%), but after cleaning the investigators found ribotypes F106, F255, F001, F027 were eliminated and F014-020 was partially reduced.

“Environmental C. difficile contamination was increased after CDI infusions and significantly reduced after cleaning with a hypochlorite solution, reducing the potential risk of spore transmission to others,” the authors wrote.

The study, “Appropriate cleaning reduces potential risk of spore transmission from patients with Clostridioides difficile infection treated in outpatient infusion centers,” was published online in Anaerobe.