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Clostridium difficile Infection in a Long-Term Care Facility: Hospital-Associated Illness Compared with Long-Term Care-Associated Illness

Published online by Cambridge University Press:  02 January 2015

Jong Hun Kim ,
Diana Toy  and
Robert R. Muder
Jong Hun Kim
Affiliation:
Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Diana Toy
Affiliation:
Infectious Disease Section, VA Pittsburgh Healthcare System, VA Medical Center, Pittsburgh, Pennsylvania
Robert R. Muder*
Affiliation:
Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania Infectious Disease Section, VA Pittsburgh Healthcare System, VA Medical Center, Pittsburgh, Pennsylvania
*
Infectious Disease Section, VA Pittsburgh Healthcare System, University Drive C, Pittsburgh, PA 15240 ([email protected])
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Abstract

Background.

Controversy exists over whether Clostridium difficile infection (CDI) commonly occurs in long-term care facility residents who have not been recently transferred from an acute care hospital.

Objective.

To assess the incidence and outcome of CDI in a long-term care facility.

Methods.

Retrospective cohort study in a 262-bed long-term care Veterans Affairs facility in Pittsburgh, Pennsylvania, for the period January 2004 through June 2010. CDI was identified by positive stool C. difficile toxin assay and acute diarrhea. Patients were categorized as hospital-associated CDI (HACDI) or long-term care facility–associated CDI (LACDI) and followed for 6 months.

Results.

The annual rate of CDI varied between 0.11 and 0.23 per 1,000 resident-days for HACDI patients and between 0.04 and 0.28 per 1,000 resident-days for LACDI patients. We identified 162 patients, 96 patients (59.3%) with HACDI and 66 patients (40.7%) with LACDI. Median age was 74 and 77 years, respectively, for HACDI and LACDI (P = .055) patients. There were more patients with at least 1 relapse of CDI during 6 months of follow up in LACDI patients (32/66, 48.5%) than in HACDI patients (28/96, 29.2%; P = .009). Logistic regression showed that ages of at least 75 years (odds ratio [OR], 2.33; 95% confidence interval [CI], 1.07–5.07; P = .033), more than 2 transfers to an acute care hospital (OR, 7.88; 95% CI, 1.88–32.95; P = .005), and LACDI (OR, 3.15; 95% CI, 1.41–7.05; P = .005) were associated with relapse of CDI.

Conclusions.

Forty percent of CDI cases were acquired within the long-term care facility, indicating a substantial degree of transmission. Optimal strategies to prevent CDI in the long-term care facility are needed.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 7 , July 2011 , pp. 656 - 660
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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References

1.Gerding, DN, Johnson, S, Peterson, LR, et al. Clostridium difficile diarrhea and colitis. Infect Control Hosp Epidemiol 1995;16:459–477.Google Scholar
2.Kim, KH, Fekety, R, Batts, DH, et al. Isolation of Clostridium difficile from the environment and contacts of patients with antibiotic-associated colitis. J Infect Dis 1981;143(1):42–50.Google Scholar
3.Pépin, J, Valiquette, L, Cossette, B. Mortality attributable to nosocomial Clostridium difficile-associated disease during an epidemic caused by a hypervirulent strain in Quebec. CMAJ 2005;173(9):1037–1042.Google Scholar
4.Makris, AT, Gelone, S. Clostridium difficile in the long-term care setting. J Am Med Dir Assoc 2007;8(5):290–299.CrossRefGoogle ScholarPubMed
5.McDonald, LC, Coignard, B, Dubberke, E, et al. Recommendations for surveillance of Clostridium difficile-associated disease. Infect Control Hosp Epidemiol 2007;28:140–145.CrossRefGoogle ScholarPubMed
6.Mylotte, JM. 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(8):760–763.Google Scholar
7.Cohen, SH, Gerding, DN, Johnson, S, et al; Society for Healthcare Epidemiology of America; Infectious Diseases Society of America. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). Infect Control Hosp Epidemiol 2010;31(5):431–455.Google Scholar
8.Chang, HT, Krezolek, D, Johnson, S, Parada, JP, Evans, CT, Gerding, DN. Onset of symptoms and time to diagnosis of Clostridium difficile-associated disease following discharge from an acute care hospital. Infect Control Hosp Epidemiol 2007;28(8):926–93l.CrossRefGoogle ScholarPubMed
9.Laffan, AM, Bellantoni, MF, Greenough, WB III, Zenilman, JM. Burden of Clostridium difficile-associated diarrhea in a long-term care facility. J Am Geriatr Soc 2006;54(7):1068–1073.Google Scholar
10.Bender, BS, Bennett, R, Laughon, BE, et al. Is Clostridium difficile endemic in chronic-care facilities? Lancet 1986;2(8497):11–13.CrossRefGoogle ScholarPubMed
11.Ellingson, K, Muder, RR, Jain, R, et al. Sustained reduction in the clinical incidence of methicillin-resistant Staphylococcus aureus colonization or infection associated with a multifaceted infection control intervention. Infect Control Hosp Epidemiol 2011;32(1):1–8.Google Scholar
12.Muder, RR, Cunningham, C, McCray, E, et al. Implementation of an industrial systems-engineering approach to reduce the incidence of methicillin-resistant Staphylococcus aureus infection. Infect Control Hosp Epidemiol 2008;29:702–708.CrossRefGoogle ScholarPubMed
13.Muder, RR, Cheryl, SL, Cunningham, C, Morris, LA, Jain, R. Hospital-associated infection due to MRSA and other multiply resistant organisms after a hospital-wide control program: 4 year follow-up. In: Programs and abstracts of the Fifth Decennial International Conference on Healthcare-Associated Infections. Atlanta: SHEA, 2010. Abstract 551.Google Scholar
14.Aseeri, M, Schroeder, T, Kramer, J, Zackula, R. Gastric acid suppression by proton pump inhibitors as a risk factor for Clostridium difficile-associated diarrhea in hospitalized patients. Am J Gastroenterol 2008;103(9):2308–2313.CrossRefGoogle ScholarPubMed
15.McFarland, LV, Surawicz, CM, Stamm, WE. Risk factors for Clostridium difficile carriage and C. difficile–associated diarrhea in a cohort of hospitalized patients. J Infect Dis 1990;162(3):678–684.CrossRefGoogle Scholar
16.Buchner, AM, Sonnenberg, A. Epidemiology of Clostridium difficile infection in a large population of hospitalized US military veterans. Dig Dis Sci 2002;47(1):201–207.CrossRefGoogle Scholar
17.Barbut, F, Richard, A, Hamadi, K, Chomette, V, Burghoffer, B, Petit, JC. Epidemiology of recurrences or reinfections of Clostridium difficile-associated diarrhea. J Clin Microbiol 2000;38(6):2386–2388.Google Scholar
18.Kyne, L, Warny, M, Qamar, A, Kelly, CP. Association between antibody response toxin A and protection against recurrent Clostridium difficile diarrhoea. Lancet 2001;357(9251):189–193.CrossRefGoogle ScholarPubMed
19.Kvach, EJ, Ferguson, D, Riska, PF, Landry, ML. Comparison of BD GeneOhm Cdiff real-time PCR assay with a two-step algorithm and a toxin A/B enzyme-linked immunosorbent assay for diagnosis of toxigenic Clostridium difficile infection. J Clin Microbiol 2010;48(1):109–114.CrossRefGoogle Scholar