LOW-RATE OF CLOSTRIDIUM-DIFFICILE COLONIZATION IN AMBULATORY AND HOSPITALIZED HIV-INFECTED PATIENTS IN A HOSPITAL UNIT - A PROSPECTIVE SURVEY

Objective: to determine the frequency of Clostridium difficile carriag e in HIV-infected in- and out-patients, and to assess the role of this carriage in nosocomial transmission of C, difficile. Patients and met hods: prospective study in a university hospital. Forty-five consecuti ve HIV-infected out-patients and 120 hospitalized patients (52 HIV and 68 non HIV-infected-patients) were studied. During the period of hosp italization, 44 patients (24 HIV and 20 non-HIV-infected patients) wit h a negative culture within 48h of admission were followed weekly for fecal carriage. Clostridium difficile culture and latex agglutination were performed on the fecal samples of each patient, In the case of po sitive culture and/or latex agglutination, C. difficile toxin assays w ere performed by microtitre cytotoxicity method.Results: out-patients: one patient was a carrier and one patient with diarrhoea was infected with a toxigenic strain (2/45, 4,5%, 95% CI=1-17), Eighty percent of the HIV-infected out-patients had received antimicrobial agents previo usly In-patients: in the first 48h, live asymptomatic patients were ca rriers (three non-HIV and two HIV-infected patients). Among 20 patient s who complained of diarrhoea, one HIV-infected patient had only a pos itive latex agglutination and one HIV-infected patient was infected wi th a toxigenic strain. Overall, 7/120 (5.8%, 95% CI = 2-10) patients w ere infected or colonized with C, difficile. During the hospitalizatio n (743 patient-days), none of the 44 patients acquired C. difficile. C onclusion: this study suggests that in this given unit, C. difficile c arriage is low, at least with single room accommodation, and in the ab sence of clusters of cases. This carriage is not different in HIV and non-HIV infected patients despite treatment with multiple antibiotics, and is not different in patients managed in different care environmen ts, The systematic identification of C. difficile carriers for isolati on and prophylactic treatment is not useful under these circumstances.