Asymptomatic carriage may fuel C difficile spread

Modeling in oncology units attributed 92% of transmission-related colonization to patients without symptomatic infection.

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In a prospective study of 384 patients in 2 leukemia and hematopoietic cell transplant units, investigators modeled C difficile acquisition and transmission.
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Across 1,000 simulations, 51% of new colonizations were attributed to importation and 49% to within-unit transmission.
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Asymptomatic colonization accounted for 87% of imported colonizations and was the modeled source of 92% of transmission events causing new colonization.
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The model estimated 3.9 new colonizations per week, compared with 0.9 detected by the observation model, indicating that many acquisitions went undetected.
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Estimates were weakly constrained by testing data from 18 CDI cases and 85 asymptomatic carriers, and the single-facility study may not generalize.

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