Presence of Clostridioides difficile and multidrug resistant healthcare-associated pathogens in stool specimens from hospitalized patients in the United States

Summary Background Healthcare-associated infections (HAI) continue to be a major cause of morbidity and mortality. Many HAI pathogens, including multidrug resistant organisms (MDROs), colonize the gastrointestinal tract. Aim The goal of this study was to determine the frequency of MDRO carriage in patients who do and do not harbor toxigenic Clostridioides difficile in their stools. Methods Stool specimens received from nine U.S. laboratories were cultured using media selective for C. difficile, Staphylococcus aureus, vancomycin-resistant enterococci (VRE), and carbapenem-resistant gram-negative organisms (CRO). Specimens and isolates were also tested by PCR. Bacterial isolates underwent susceptibility testing and genotyping. Findings. Among 363 specimens, 175 yielded toxigenic C. difficile isolates spanning 27 PCR ribotypes. C. difficile (TCD+) stools harbored an additional 28 organisms, including six CRO (3.4%), of which two (1.1%) were carbapenemase producing organism (CPO), 19 VRE (10.9%), and three meticillin-resistant S. aureus isolates (MRSA 1.7 %). Stools that were culture negative for toxigenic-C. difficile (TCD-) yielded 26 organisms, including four CROs (2.1%), 20 VREs (10.6), and two MRSA (1.1%). Excluding C. difficile, no significant differences were seen in the rates of the MDROs between TCD+ and TCD-specimens. Conclusion Overall, 15.4% of the TCD+ stools and 11.2% of the TCD-stools carried at least one non-C. difficile MDRO pathogen, indicating that multiple MDROs may be present in the gastrointestinal tracts of patients, including those that harbor C. difficile.