{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T01:13:21Z","timestamp":1778807601043,"version":"3.51.4"},"posted":{"date-parts":[[2026,5,12]]},"group-title":"Infectious Diseases (except HIV\/AIDS)","reference-count":31,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,5,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>\n                    Leukemic and hematopoietic cell transplant patients have one of the highest incidences of\n                    <jats:italic>C. difficile<\/jats:italic>\n                    infection (CDI). While CDI patients are considered the primary source of transmission, asymptomatic colonized patients (AC) can progress to CDI or contribute to in-unit transmission. We aim to quantify the roles of CDI and AC patients in\n                    <jats:italic>C. difficile<\/jats:italic>\n                    importation and transmission within oncological units.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Prospective cohort study<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Two leukemia and HCT transplant units in a large tertiary care hospital in the US<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>\n                    We developed a stochastic, individual-based network model to simulate\n                    <jats:italic>C. difficile<\/jats:italic>\n                    acquisition and transmission. Data from cultures and nucleic acid amplification testing (NAAT) obtained at admission and weekly, and toxin enzyme immunoassay (EIA) tests used for CDI diagnosis were used to calibrate the model. Healthcare worker room assignments informed the network structure. Key parameters were estimated via particle filtering.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The model reproduced observed weekly test counts and transmission pairs. AC patients were the primary source of new colonizations: 51% were due to importation (of those, 88% were admitted as AC), and 49% were due to transmission (AC was the source in 92% of transmissions). Sensitivity analysis showed that these findings were most influenced by the colonization rate and rates of environmental contamination and cleaning.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>\n                    These findings reinforce the role of AC, particularly via admission importation, in sustaining\n                    <jats:italic>C. difficile<\/jats:italic>\n                    transmission in high-risk hospital settings. Infection control focused on CDI effectively reduced onward transmission, as indicated by CDI\u2019s low contribution to new colonizations.\n                  <\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.05.08.26352751","type":"posted-content","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T14:26:44Z","timestamp":1778596004000},"source":"Crossref","is-referenced-by-count":0,"title":["Quantifying the contributions of asymptomatic and symptomatic colonized patients to\n                  <i>Clostridioides difficile<\/i>\n                  acquisition in oncological units"],"prefix":"10.64898","author":[{"given":"Savannah","family":"Curtis","sequence":"first","affiliation":[{"name":"Department of Mathematics, North Carolina State University, Raleigh, NC, USA,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary M.","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tiffany","family":"Hink","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kimberly A.","family":"Reske","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily","family":"Struttmann","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zainab","family":"Hassan Iqbal","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Candice","family":"Cass","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margaret A.","family":"Olsen","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sankalp","family":"Arya","sequence":"additional","affiliation":[{"name":"Department of Population Health and Pathobiology, North Carolina State University, Raleigh, NC, USA,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carey-Ann","family":"Burnham","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suzanne","family":"Lenhart","sequence":"additional","affiliation":[{"name":"Department of Mathematics, University of Tennessee, Knoxville, TN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erik R.","family":"Dubberke","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4039-0336","authenticated-orcid":false,"given":"Cristina","family":"Lanzas","sequence":"additional","affiliation":[{"name":"Department of Population Health and Pathobiology, North Carolina State University, Raleigh, NC, USA,"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"issue":"18","key":"2026051417402691000_2026.05.08.26352751v1.1","first-page":"1732","article-title":"Changes in Prevalence of Health Care\u2013Associated Infections in U","volume":"379","year":"2018","journal-title":"S. 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