Clostridium difficile Infection It's a Family Affair

Abstract

This paper reports on 6 cases of paired Clostridium difficile infection (CDI) identified over a 5-year period that occurred within the respective families, which highlights the potential for intrafamilial spread of CDI in both community and hospital settings (UK). The authors subsequently undertook a search of all microbiologically confirmed cases of CDI during the period 2007-2012. Individuals who shared the same surname or same address were identified for additional investigation. All putative case-pairs identified were reviewed to identify potential epidemiological associations; this included ribotyping of available C. difficile isolates and, when possible, multiple-locus variable number tandem repeat analysis (MLVA). Six cases of paired CDI were identified. Review of the paired cases of CDI, taken together with indistinguishable ribotypes and their temporal association, is highly suggestive of an epidemiological link and thus highlights the potential for spread within families. Interestingly, 2 of 3 contact patients had their own independent risk factors for CDI. In addition, the apparent transmission from a GDH-positive but toxin-negative patient to her spouse, who went on to develop active CDI, is also of particular note. Although the clinical significance of isolating C. difficile in an infant is not clear, as in the last case-pair, the matching ribotypes suggest a putative link between the 2 cases.