Quantifying transmission of Clostridium difficile within and outside healthcare settings

David P. Durham, Margaret A. Olsen, Erik R. Dubberke, Alison P. Galvani, Jeffrey P. Townsend

Research output: Contribution to journalArticlepeer-review

39 Scopus citations


To quantify the effect of hospital and community-based transmission and control measures on Clostridium difficile infection (CDI), we constructed a transmission model within and between hospital, community, and long-term care-facility settings. By parameterizing the model from national databases and calibrating it to C. difficile prevalence and CDI incidence, we found that hospitalized patients with CDI transmit C. difficile at a rate 15 (95% CI 7.2-32) times that of asymptomatic patients. Long-term care facility residents transmit at a rate of 27% (95% CI 13%-51%) that of hospitalized patients, and persons in the community at a rate of 0.1% (95% CI 0.062%-0.2%) that of hospitalized patients. Despite lower transmission rates for asymptomatic carriers and community sources, these transmission routes have a substantial effect on hospital-onset CDI because of the larger reservoir of hospitalized carriers and persons in the community. Asymptomatic carriers and community sources should be accounted for when designing and evaluating control interventions.

Original languageEnglish
Pages (from-to)608-616
Number of pages9
JournalEmerging Infectious Diseases
Issue number4
StatePublished - Apr 2016


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