In Search of CDI: The Plop Thickens, Part 2

Reviewed By: John A. Sellick, DO, MS, University at Buffalo Jacobs School of Medicine and Biomedical Sciences

The presumption of current mandatory reporting is that some Clostridioides difficile infections (CDI) are hospital acquired. This determination is made entirely on the basis of the time from admission to when the infection occurs. However, emerging data indicate that this presumption may not always be correct.

Gonzalez–Orta and colleagues at the Cleveland VA did a prospective, 6-month study to attempt to expand knowledge in this area. Study patients, who did not have diarrhea and did not have an episode of CDI in the prior 8 weeks, had rectal swabs for C. difficile culture performed at the time of admission. They then were followed for the development of CDI. If they had greater than 3 episodes of diarrhea/day occurring after the third hospital day, and the commercial PCR assay for C. difficile was positive, that stool specimen was also cultured. Organisms were then compared by whole genome sequencing.

480 patients were enrolled during the study, and 68 had C. difficile colonization at admission. 6 patients were diagnosed with hospital-acquired CDI and 3 of these were found to have genetically identical screening/clinical organisms. 5 additional patients who had negative admission cultures were diagnosed with CDI. In total, 3 of 11 (27%) patients with hospital-acquired CDI had identical screening/clinical organisms.

While this was a limited sample of patients from a single facility, it nonetheless points out that a substantial portion of reportable CDI may actually be due to strains harbored by the patients at the time of admission. This emphasizes the importance of diagnostic and antimicrobial stewardship to minimize reporting of CDI that may not actually be hospital acquired.


Gonzalez-Orta M, Saldana C, Ng-Wong Y, Cadnum J, Jencson A, Jinadatha C, Donskey CJ. Are Many Patients Diagnosed with Healthcare-associated Clostridioides difficile Infections Colonized with the Infecting Strain on Admission? Clin Infect Dis. 2019;69:1801-14. PMID:30855075

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