Household exposure to Clostridioides difficile increases acquisition risk

  • Miller AC & al.
  • JAMA Netw Open
  • 1 Jun 2020

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • Although absolute risk is low vs other risk factors, sharing a household with a family member who has a Clostridioides difficile infection (CDI) appears to increase likelihood of transmission/acquisition.

Why this matters

  • Educate patients with confirmed CDI about risk for other household members, including need for testing following diarrhea exposure and the importance of effectively cleaning shared bathrooms.

Key results

  • 224,818 cases; 194,424 enrollees.
  • 40.1% (90,212) hospital-onset; 1074 cases (1050 people) followed prior to CDI event in a household member.
  • On stratified regression across all cases, increased CDI risk (incident rate ratios [IRRs]; 95% CIs) seen with: 
    • Prior hospital exposure: 16.18 (15.31-17.10). 
    • Family exposure: 12.47 (8.86-16.97). 
    • Age ≥65 years: 9.90 (8.93-10.98).
    • Female sex: 1.44 (1.36-1.53). 
  • Community-onset CDI alone: IRR, 16.00 (95% CI, 11.72-21.22).
  • Community-onset CDI without prior hospitalization: IRR, 21.74 (95% CI, 15.12-30.01).
  • Family exposure with prior hospitalization was associated with significantly greater incidence of hospital-onset CDI: IRR, 6.73 (95% CI, 3.30-12.00).
  • Prior family CDI exposure in ages 18-26 years was nonsignificant.

Study design

  • Case-control study assessing incidence of potential CDI household transmission based on longitudinal insurance claims (CDI incidence in monthly enrollment stratum).
  • Funding: CDC.

Limitations

  • Bias toward the null.
  • Missing confounders.