Epidemiology of Clostridium difficile and vancomycin-resistant Enterococcus colonization in patients on a spinal cord injury unit

Background/objective: Patients with spinal cord injury (SCI) are at risk of acquiring colonization with Clostridium difficile and vancomycin-resistant Enterococcus (VRE) due to prolonged hospitalization and frequent antimicrobial use. We examined the frequency of stool, skin, and environmental contamination with C. difficile and VRE in hospitalized patients with SCI. Methods: We performed a cross-sectional study of 22 hospitalized patients with SCI with no symptoms of C. difficile infection. Stool samples, skin, and environmental sites were cultured for C. difficile and VRE, and polymerase chain reaction ribotyping was performed for C. difficile isolates. Fisher's exact test was used to compare the proportions of skin and environmental contamination among stool carriers and non-carriers. Univariate analysis was used to assess factors associated with asymptomatic carriage of C. difficile. Results: Of 22 asymptomatic patients, 11 (50%) were asymptomatic carriers of toxigenic C. difficile and 12 (55%) were carriers of VRE. In comparison with non-carriers, asymptomatic carriers of toxigenic C. difficile had higher rates of skin (45 versus 9%) (P=0.07) and environmental contamination (55 versus 9%) (P=0.03) and longer length of stay (median, 57 versus 6 days; P=0.04). A majority of skin and environmental C. difficile isolates from individuals were identical to isolates from stool. In comparison with non-carriers, patients with VRE stool colonization had non-significant trends toward more frequent skin (27 versus 9%) and environmental (18 versus 9%) contamination. Conclusion: Asymptomatic stool carriage of toxigenic C. difficile and VRE was common on an acute-care SCI unit. Asymptomatic carriers of toxigenic C. difficile had frequent skin and environmental contamination, suggesting the potential to contribute to transmission.