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In a new study, researchers modeled the transmission of Clostridioides difficile (C. diff) infections among patients in hospital cancer units. They found that most new infections were introduced by patients who were infected but not symptomatic at the time of admission, rather than by patients who were infected and symptomatic. The model provides a clearer picture of C. diff transmission events in oncology wards and could help inform protocols aimed at preventing future disease transmission in a highly susceptible population.

Cancer treatments, while increasingly effective, leave their recipients immunocompromised and at greater risk of contracting infections than the general population. Hospital-acquired infections can cause severe complications in cancer patients, and C. diff is one of the most common.

"Physicians have singled out antimicrobial resistance as a big issue for improvement in cancer patients," says Cristina Lanzas, professor of infectious disease at North Carolina State University's College of Veterinary Medicine and corresponding author of the research.

"The cancer treatments are improved, but the secondary infections patients get because they are so immunocompromised can be fatal. We decided to look at how C. diff infections were transmitted in oncology wards."

Generally speaking, clinicians test patients for C. diff only when they have clinical signs; however, patients can also carry this pathogen in the gut without symptoms and may contribute to its transmission.

The researchers combined six months of active patient surveillance (testing patients for C.

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