Volume 30, Number 5—May 2024
Research
Identifying Contact Time Required for Secondary Transmission of Clostridioides difficile Infections by Using Real-Time Locating System
Table 1
Characteristics | All patients | Patients with subsequent CDI |
Patients without subsequent CDI | p value‡ | ||
---|---|---|---|---|---|---|
Secondary transmission | Nonsecondary transmission | p value† | ||||
Total no. patients | 2,520 | 2 | 56 | NA | 2,462 | NA |
Mean age, y (SD) |
60.4 (19.8) |
81.5 (2.1) |
73.4 (11.6) |
<0.001 |
60.06 (19.80) |
0.091 |
Sex | ||||||
M | 1,343 (53.3) | 2 (100.0) | 31 (55.4) | >0.99 | 1,310 (53.2) | NA |
F |
1,177 (46.7) |
NA |
NA |
NA |
NA |
NA |
Prior hospitalization | 381 (15.1) | 0 | 18 (32.1) | >0.99 | 263 (14.7) | 0.153 |
Recent antimicrobials |
1,686 (66.9) |
2 (100.0) |
54 (96.4) |
>0.99 |
1,630 (66.2) |
0.047 |
Underlying conditions | ||||||
Diabetes mellitus | 765 (30.4) | 1 (50.0) | 25 (44.6) | 0.881 | 739 (30.0) | 0.600 |
COPD | 91 (3.6) | 0 | 6 (10.7) | >0.99 | 85 (3.5) | 0.926 |
Chronic heart failure | 617 (24.5) | 1 (50.0) | 28 (50.0) | >0.99 | 588 (23.9) | 0.876 |
Hypertension | 1,131 (44.9) | 1 (50.0) | 36 (64.3) | 0.683 | 1,094 (44.4) | 0.521 |
Chronic kidney disease | 341 (13.5) | 0 | 18 (32.1) | >0.99 | 323 (13.1) | 0.633 |
Malignancy | 640 (25.4) | 1 (50.0) | 21 (37.5) | 0.723 | 618 (25.1) | 0.905 |
IBD | 1 (0.0) | 0 | 0 | NA | 1 (0.0) | NA |
CVA | 279 (11.1) | 0 | 11 (19.6) | >0.99 | 268 (10.9) | NA |
HSCT |
104 (4.1) |
0 |
8 (14.3) |
>0.99 |
96 (3.9) |
0.821 |
Median CCI score (IQR) | 2 (0–3) | 2.5 (2.25–2.75) | 4 (2–6) | 0.447 | 2 (0–4) | 0.387 |
No. days before index patient treatment, median (IQR) |
1 (0–2) |
1.5 (1.25–1.75) |
1 (0–2) |
>0.99 |
1 (0–2) |
NA |
Laboratory tests | ||||||
Blood leukocyte count >15,000/µL | 244 (11.2) | 0 | 12 (22.2) | >0.99 | 232 (10.9) | 0.710 |
Median CRP, mg/L (IQR) | 3.9 (0.6–34.7) | 53.3 (44–62.6) | 42.9 (16.3–93.2) | 0.794 | 4.8 (0.7–40.4) | 0.209 |
Mean albumin, g/dL (SD) |
3.05 (0.54) |
3.15 (0.35) |
3.10 (0.55) |
0.890 |
2.96 (0.55) |
NA |
Clinical conditions | ||||||
Ileostomy | 29 (1.2) | 0 | 1 (1.8) | >0.99 | 28 (1.1) | NA |
Enteral tube insertion | 325 (12.9) | 2 (100.0) | 21 (37.5) | >0.99 | 302 (12.3) | 0.201 |
No. contact cases§ |
3,620 |
2 |
124 |
3,494 |
||
Group 1¶ | 909 (25.1) | 1 (50.0) | 43 (34.7) | >0.99 | 865 (24.7) | 0.516 |
Room sharing# | 181 (19.9) | 0 | 11 (25.6) | >0.99 | 170 (19.7) | NA |
Contact during diarrhea episode** |
316 (34.8) |
0 |
13 (30.2) |
>0.99 |
303 (35.0) |
NA |
Group 2†† | 421 (11.6) | 0 | 11 (8.9) | >0.99 | 410 (11.7) | NA |
Group 3‡‡ | 2,290 (63.3) | 1 (50.0) | 70 (56.5) | >0.99 | 2,219 (63.5) | NA |
Median contact time, min (IQR) | 4,320 (131.5–8,640) | 7,976.5 (4,044.75–11,908.25) | 4,320 (133.25–10,080.0) | 0.465 | 4,320 (132–8,640) | NA |
No. deaths | 162 (6.4) | 0 | 11 (19.6) | >0.99 | 151 (6.1) | NA |
*Values are no. (%) except as indicated. CCI, Charlson comorbidity index; CDI, Clostridioides difficile infection; COPD, chronic obstructive pulmonary disease; CRP, C-reactive protein; CVA, cerebrovascular accident; HSCT, hematopoietic stem cell transplantation; IBD, inflammatory bowel disease; IQR, interquartile range; NA, not applicable. †A univariate logistic regression was used to compute p values, comparing secondary transmission with nonsecondary transmission. ‡A generalized linear mixed model was used to compute p values after adjusting for variables exhibiting statistical significance in the univariate analysis; the model was used to elucidate the odds of subsequent CDI occurrence. The odds ratios and 95% CIs for each variable are shown in Appendix 1 Table 2. §Because 744 patients experienced >2 episodes of contact with separate index patients, a disparity emerged between the number of contact cases and the number of contact patients. ¶Group 1 included patients who had direct contact with index patients. #Co-hospitalization in the same bedroom with the index patient for >24 hours. **Contact with index patient who had diarrhea. ††Group 2 included patients who had indirect contact with index patients via healthcare personnel. ‡‡Group 3 included patients who had indirect contact with index patients via the environment.
1These authors contributed equally to this article.