Acquisition of Clostridium difficile by hospitalized patients: evidence for colonized new admissions as a source of infection

J Infect Dis. 1992 Sep;166(3):561-7. doi: 10.1093/infdis/166.3.561.


The frequency of introduction and spread of specific Clostridium difficile strains among hospitalized patients were assessed by serial cultures of patients admitted to a medical-surgical ward with endemic C. difficile-associated diarrhea. Stool cultures were obtained from 634 (94%) of 678 consecutive admissions to the ward (ward admissions), and all C. difficile isolates were typed by restriction endonuclease analysis. Sixty-five ward admissions introduced C. difficile to the ward, and 54 initially culture-negative admissions acquired C. difficile on the ward. Ward admissions hospitalized within the prior 30 days in the medical center were more likely to be culture-positive for C. difficile at admission to the study ward than those not previously hospitalized at the institution (16% vs. 7%, P less than .001). Nosocomial acquisition of a C. difficile strain was preceded by a documented introduction of that strain to the ward by another asymptomatic ward admission in 16 (84%) of 19 instances, suggesting that C. difficile-colonized new admissions are a major source of nosocomial C. difficile infections.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Bacterial Typing Techniques
  • Clostridium Infections / epidemiology
  • Clostridium Infections / etiology*
  • Clostridium Infections / microbiology
  • Clostridium difficile / classification
  • Clostridium difficile / genetics
  • Clostridium difficile / isolation & purification*
  • Cross Infection / epidemiology
  • Cross Infection / etiology*
  • Cross Infection / microbiology
  • DNA Restriction Enzymes / metabolism
  • DNA, Bacterial / metabolism
  • Humans
  • Inpatients
  • Minnesota / epidemiology
  • Prospective Studies
  • Regression Analysis


  • DNA, Bacterial
  • DNA Restriction Enzymes