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Acquisition of Clostridium difficile Colonization and Infection After Transfer From a Veterans Affairs Hospital to an Affiliated Long-Term Care Facility

Published online by Cambridge University Press:  11 July 2017

Suresh Ponnada ,
Dubert M. Guerrero ,
Lucy A. Jury ,
Michelle M. Nerandzic ,
Jennifer L. Cadnum ,
M. Jahangir Alam  and
Curtis J. Donskey
Suresh Ponnada
Affiliation:
Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
Dubert M. Guerrero
Affiliation:
Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio University Hospitals Cleveland Medical Center, Cleveland, Ohio
Lucy A. Jury
Affiliation:
Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
Michelle M. Nerandzic
Affiliation:
Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
Jennifer L. Cadnum
Affiliation:
Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
M. Jahangir Alam
Affiliation:
College of Pharmacy, University of Houston, Houston, Texas
Curtis J. Donskey*
Affiliation:
Geriatric Research, Education and Clinical Center, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio Case Western Reserve University School of Medicine, Cleveland, Ohio
*
Address correspondence to Curtis J. Donskey, MD, Geriatric Research, Education and Clinical Center, Louis Stokes Veterans Affairs Medical Center, 10701 East Blvd, Cleveland, OH 44106 ([email protected]).
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Abstract

BACKGROUND

Clostridium difficile infection (CDI) and asymptomatic carriage of toxigenic C. difficile are common in long-term care facilities (LTCFs). However, whether C. difficile is frequently acquired in the LTCF versus during acute-care admissions remains unknown.

OBJECTIVE

To test the hypothesis that LTCF residents often acquire C. difficile colonization and infection in the LTCF

DESIGN

This 5-month cohort study was conducted to determine the incidence of acquisition of C. difficile colonization and infection in asymptomatic patients transferred from a Veterans Affairs hospital to an affiliated LTCF.

METHODS

Rectal swabs were cultured for toxigenic C. difficile at the time of transfer to the LTCF and weekly for up to 6 weeks. We calculated the proportion of LTCF-onset CDI cases within 1 month of transfer that occurred in residents colonized on admission versus those with new acquisition in the LTCF.

RESULTS

Of 110 patients transferred to the LTCF, 12 (11%) were asymptomatically colonized with toxigenic C. difficile upon admission, and 4 of these 12 patients (33%) developed CDI within 1 month, including 3 recurrent and 1 initial CDI episode. Of 82 patients with negative cultures on transfer and at least 1 follow-up culture, 22 (27%) acquired toxigenic C. difficile colonization, and 4 developed CDI within 1 month, including 1 recurrent and 3 initial CDI episodes.

CONCLUSION

LTCF residents frequently acquired colonization with toxigenic C. difficile after transfer from the hospital, and 3 of 4 initial CDI cases with onset within 1 month of transfer occurred in residents who acquired colonization in the LTCF.

Infect Control Hosp Epidemiol 2017;38:1070–1076

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 9 , September 2017 , pp. 1070 - 1076
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

REFERENCES

1. Lessa, FC, Mu, Y, Bamberg, WM, et al. Burden of Clostridium difficile infection in the United States. N Engl J Med 2015;372:825–834.CrossRefGoogle ScholarPubMed
2. Guerrero, DM, Nerandzic, MM, Jury, LA, Chang, S, Jump, RL, Donskey, CJ. Clostridium difficile infection in a Department of Veterans Affairs long-term care facility. Infect Control Hosp Epidemiol 2011;32:513–515.Google Scholar
3. Pawar, D, Tsay, R, Nelson, DS, Elumalai, MK, Lessa, FC, Clifford McDonald, L, Dumyati, G. Burden of Clostridium difficile infection in long-term care facilities in Monroe County, New York. Infect Control Hosp Epidemiol 2012;33:1107–1112.Google Scholar
4. Hunter, JC, Mu, Y, Dumyati, GK, et al. Burden of nursing home-onset Clostridium difficile infection in the United States: estimates of incidence and patient outcomes. Open Forum Infect Dis 2016;3:ofv196. doi: 10.1093/ofid/ofv196.Google Scholar
5. Campbell, R, Giljahn, L, Machesky, K, et al. Clostridium difficile infection in Ohio hospitals and nursing homes during 2006. Infect Control Hosp Epidemiol 2009;30:526–533.CrossRefGoogle ScholarPubMed
6. Riggs, MM, Sethi, AK, Zabarsky, TF, et al. Asymptomatic carriers are a potential source for transmission of epidemic and nonepidemic Clostridium difficile strains among long-term care facility residents. Clin Infect Dis 2007;45:992–998.Google Scholar
7. Jinno, S, Kundrapu, S, Guerrero, DM, et al. Potential for transmission of Clostridium difficile by asymptomatic acute care patients and long-term care facility residents with prior C. difficile infection. Infect Control Hosp Epidemiol 2012;33:638–639.Google Scholar
8. Simor, AE, Bradley, SF, Strausbaugh, LJ, et al. Clostridium difficile in long-term-care facilities for the elderly. Infect Control Hosp Epidemiol 2002;23:696–703.Google Scholar
9. Marciniak, C, Chen, D, Stein, AC, et al. Prevalence of Clostridium difficile colonization at admission to rehabilitation. Arch Phys Med Rehabil 2006;87:1086–1090.Google Scholar
10. Sethi, AK, Al-Nassir, WN, Nerandzic, MM, et al. Persistence of skin contamination and environmental shedding of Clostridium difficile during and after treatment of C. difficile infection. Infect Control Hosp Epidemiol 2010;31:21–27.Google Scholar
11. McDonald, L, Coignard, B, Dubberke, E, Song, X, Horan, T, Kutty, P. Recommendations for surveillance of Clostridium difficile-associated disease. Infect Control Hosp Epidemiol 2007;28:140–145.Google Scholar
12. Mylotte, J. Surveillance for Clostridium difficile-associated diarrhea in long-term care facilities: what you get is not what you see. Infect Control Hosp Epidemiol 2008;29:760–763.Google Scholar
13. Kim, JH, Toy, D, Muder, RR. Clostridium difficile infection in a long-term care facility: hospital-associated illness compared with long-term care-associated illness. Infect Control Hosp Epidemiol 2011;32:656–660.CrossRefGoogle Scholar
14. Mylotte, JM, Russell, S, Sackett, B, Vallone, M, Antalek, M. Surveillance for Clostridium difficile infection in nursing homes. J Am Geriatr Soc 2013;61:122–125.CrossRefGoogle ScholarPubMed
15. Laboratory-identified multidrug-resistant organism (MDRO) and Clostridium difficile infection (CDI) events for long-term care facilities. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/PDFs/LTC/LTCF-LabID-Event-Protocol_FINAL_8-24-12.pdf. Published 2012. Accessed June 16, 2017.Google Scholar
16. Vital signs: preventing Clostridium difficile infections. MMWR Morb Mortal Wkly Rep 2012;61:157–162.Google Scholar
17. Martinson, JN, Broadaway, S, Lohman, E, et al. Evaluation of portability and cost of a fluorescent PCR ribotyping protocol for Clostridium difficile epidemiology. J Clin Microbiol 2015;53:1192–1197.Google Scholar
18. Terhes, G, Urban, E, Soki, J, Hamid, KA, Nagy, E. Community-acquired Clostridium difficile diarrhea caused by binary toxin, toxin A, and 225 toxin B gene-positive isolates in Hungary. J Clin Microbiol 2004;42:4316–4318.Google Scholar
19. Guerrero, DM, Chou, C, Jury, LA, Nerandzic, MM, Cadnum, JL, Donskey, CJ. Clinical and infection control implications of Clostridium difficile infection with negative enzyme immunoassay for toxin. Clin Infect Dis 2011;53:287–290.Google Scholar
20. Abujamel, T, Cadnum, JL, Jury, LA, Sunkesula, VC, Kundrapu, S, Jump, RL, Stintzi, AC, Donskey, CJ. Defining the vulnerable period for re-establishment of Clostridium difficile colonization after treatment of C. difficile infection with oral vancomycin or metronidazole. PLoS One 2013;8:e76269.Google Scholar
21. Hensgens, MP, Goorhuis, A, Dekkers, OM, Kuijper, EJ. Time interval of increased risk for Clostridium difficile infection after exposure to antibiotics. J Antimicrob Chemother 2012;67:742–748.Google Scholar
22. Arvand, M, Moser, V, Schwehn, C, Bettge-Weller, G, Hensgens, MP, Kuijper, EJ. High prevalence of Clostridium difficile colonization among nursing home residents in Hesse, Germany. PLoS One 2012;7:e30183.Google Scholar
23. Rogers, DS, Kundrapu, S, Sunkesula, VC, Donskey, CJ. Comparison of perirectal versus rectal swabs for detection of asymptomatic carriers of toxigenic Clostridium difficile . J Clin Microbiol 2013;51:3421–3422.Google Scholar
24. Han, JH, Maslow, J, Han, X, et al. Risk factors for the development of gastrointestinal colonization with fluoroquinolone-resistant Escherichia coli in residents of long-term care facilities. J Infect Dis 2014;209:420–425.Google Scholar
25. Fisch, J, Lansing, B, Wang, L, Symons, K, Cherian, K, McNamara, S, Mody, L. New acquisition of antibiotic-resistant organisms in skilled nursing facilities. J Clin Microbiol 2012;50:1698–1703.Google Scholar
26. Reeves, JS, Evans, ME, Simbartl, LA, Kralovic, SM, Kelly, AA, Jain, R, Roselle, GA. Clostridium difficile infections in Veterans Health Administration long-term care facilities. Infect Control Hosp Epidemiol 2016;37:295–300.Google Scholar
27. Brown, KA, Jones, M, Daneman, N, Adler, FR, Stevens, V, Nechodom, KE, Goetz, MB, Samore, MH, Mayer, J. Importation, antibiotics, and Clostridium difficile infection in veteran long-term care: a multilevel case-control study. Ann Intern Med 2016;164:787–794.CrossRefGoogle ScholarPubMed