# Asymptomatic Colonization and Transmission of Clostridium difficile in Solid Organ Transplant Patients

> **NIH NIH K23** · MEDICAL UNIVERSITY OF SOUTH CAROLINA · 2020 · $200,372

## Abstract

Project Summary / Abstract
The incidence of Clostridium difficile infections (CDI) has increased substantially since 2000. CDIs result in an
estimated 453,000 cases and 29,000 deaths each year in the United States alone and impart an estimated $
4.8 billion in excess US healthcare expenditures on a potentially preventable healthcare-associated infection.
Vulnerable populations of immunosuppressed patients with frequent contact with healthcare environments and
high prevalence of antimicrobial use such as solid organ transplant (SOT) patients have extraordinarily high
incidence rates of CDI, which results in excess mortality and graft loss post transplantation. Despite widely
publicized infection prevention measures that have been successful in controlling hospital epidemics of C.
difficile, the goal of zero incident hospital-acquired C. difficile infections has remained elusive, particularly in
SOT patients. In my prior research, I have shown that CDI is frequently related to transmission from
asymptomatic carriers of C. difficile, who outnumber patients with CDI within hospitals. The prevalence of
asymptomatic colonization (AC) in SOT patients, the role of AC in CDI transmission to SOT patients, the long-
term outcome of AC, and the origins of AC among SOT patients are all poorly understood. With their extremely
high incidence rates of CDI, SOT patients are an ideal patient group to study the hypothesis that CDI results
from widespread prevalence of AC related to frequent contact with healthcare environments rather than the
alternative hypothesis that host susceptibility mediated by post-transplant immunosuppression and antibiotic
exposures plays the greatest role in CDI in SOT patients. In this application, I propose a series of studies in C.
difficile and hospital epidemiology that test the hypothesis that AC and CDI in SOT patients results principally
from exposure to C. difficile-contaminated outpatient clinics, inpatient environments, and other SOT patients
with AC. The present career development proposal seeks to extend my previous training and experience in
infectious diseases epidemiology to include advanced cohort and survival analysis techniques as well as
facility in analysis of whole genome sequencing data, which is fast becoming the new standard method in for
the molecular epidemiology of C. difficile transmission, in order to complete my research aims in a prospective
cohort of SOT patients.

## Key facts

- **NIH application ID:** 9953970
- **Project number:** 5K23AI125607-05
- **Recipient organization:** MEDICAL UNIVERSITY OF SOUTH CAROLINA
- **Principal Investigator:** Scott R Curry
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $200,372
- **Award type:** 5
- **Project period:** 2016-07-05 → 2021-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9953970

## Citation

> US National Institutes of Health, RePORTER application 9953970, Asymptomatic Colonization and Transmission of Clostridium difficile in Solid Organ Transplant Patients (5K23AI125607-05). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9953970. Licensed CC0.

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