Family members of hospitalized patients at increased risk of CDI

Living in the same household as a hospitalized person could increase the risk of developing Clostridium difficile infection (CDI).

A team, led by Aaron C. Miller, PhD, University of Iowa, determined whether hospitalized patients without CDIs increased the risk of infection among their family members after discharge.

C Difficult studies

The majority of studies on CDI have focused on preventing the spread of nosocomial infections.

“Asymptomatic It’s hard carriers discharged from hospitals could be a major source of community-associated CDI cases,” the authors wrote. “Although healthcare-associated CDI remains a significant problem, there is also a need for greater focus on community-associated CDI cases.”

Although there are likely similar risk factors between nosocomial CDI and community-spread Cdifficile infections with respect to antibiotic use and age, there could be unique risk factors in the community, including food and pets, and the presence of a symptomatic family member.

Insurance data

In the study, investigators used U.S. insurance claims data between 2001 and 2017 to compare the monthly incidence of CDI between individuals in households with and without a family member hospitalized over the years. previous 60 days.

The study population included patients with at least 2 family members who could be identified on the same insurance plan. Overall, there were over 142 million enrollees with at least 2 family members enrolled in the same insurance plan for an entire month, with over 5.1 billion total enrollments for the entire month. study period of 17 years.

In this group, 224,818 cases of CDI were identified among 194,424 enrolled.

The analysis was based on the monthly incidence of CDI. Investigators also used a regression model to stratify enrollees into monthly enrollment strata based on year and month, as well as other demographic and patient characteristics, including age, gender, previous use of antimicrobials, use of proton pump inhibitors, presence of an infant less than 2 years of age in the household, and exposure to a recently hospitalized family member.

Incidence rate

Overall, they found that the incidence of C difficile infections among policyholders exposed to a recently hospitalized family member was 73% higher than among unexposed policyholders. The incidence also increased the length of hospitalization of family members.

The incidence rate of CDI was also higher among enrollees in households of recently hospitalized members. Cases increased from 3.22 cases per 100,000 months of enrollment for 9 days of hospitalization within the household to 8.73 cases per 100,000 months of enrollment for more than 30 days of total hospitalization within Household.

The investigators found a dose-response relationship between the total number of hospital days within the household and the CDI incidence rate ratio.

The incidence rate ratio decreased from 1.30 (95% CI, 1.19-1.41) for 1 to 3 days of hospitalization to 2.45 (95% CI, 1.66-3 .60 for family members of those hospitalized for more than 30 days.


Finally, the investigators found that known risk factors were associated with a higher incidence rate of CDI. For example, exposure to antimicrobials was linked to an increased incidence rate.

For antibiotics at low risk of CDI, the IRR was 2.69 (95% CI, 2.59-2.79, compared to an IRR of 8.83 (95% CI, 8.63- 9.03) for antibiotics at high risk of CDI.

PPI use was also associated with a statistically significant incidence rate, with an IRR of 2.23 (95% CI, 2.15-2.30).

“In this study, we found that individuals exposed to recently hospitalized family members had a significantly increased risk of CDI within 60 days of the family member’s discharge from hospital,” the authors wrote. . “Because family members who were recently hospitalized and discharged during or after their hospitalization were not diagnosed with CDI, and because the people in our analysis were not hospitalized themselves, the increased risk could be attributable to asymptomatic. It’s hard colonization at the time of discharge from the hospital in the hospitalized family member”.

The study, “Risk of asymptomatic transmission of Clostridioides difficile infection associated with recently hospitalized family members,” was published online in Emerging infectious diseases.

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