339. Burden of Clostridium difficile Infection in Long-Term Care Facilities in Monroe County, New York
Session: Poster Abstract Session: Clostridium difficile - Epidemiology, Diagnosis, Treatment, and Prevention
Friday, October 21, 2011
Room: Poster Hall B1

Background: While long-term care facility (LTCF) residents are at great risk of C. difficile infection (CDI), little is known about the relationship between acute care exposure and CDI in LTCFs. Our objective is to describe incidence, recurrence, and severity of CDI among LTCF residents, and describe the relationship between CDI in LTCFs and recent hospitalizations.


Methods: Population-based surveillance for CDI, including residents of LTCFs in Monroe County, was conducted from January–December 2010. A CDI case was defined as a positive C.difficile stool specimen by toxin or molecular assay >8 weeks after last positive specimen. CDI cases were classified as LTCF-onset (LTCO) if the positive specimen was obtained at a LTCF or <4 days after hospital admission from a LTCF. Medical records were reviewed for all LTCO cases for demographics, clinical outcome, and recurrence (i.e. positive C. difficile specimen between 2 -8 weeks after last positive specimen). Variables were compared using χ2 and t-test.


Results: 425 LTCO CDI cases were identified, of which 216 (51%) developed CDI ≤ 30 days after hospital discharge, 272 (64%) within 12 weeks (Figure 1). The overall incidence in the 33 Monroe County LTCFs was 2.3 /10,000 patient-days (IQR: 1.2-3.3). The mean age of LTCO cases was 81 years (SD: 12.3), 65% were female, and 68% were white. Recurrence occurred in 128 (30%) of LTCO cases; LTCO cases who were older (mean age 83.3 vs. 79.7 years, p=0.004) and female (73% vs. 62%, p=0.03) were more likely to have recurrences. Seventy cases (16%) were hospitalized due to CDI, of which 70% had severe CDI, defined by ileus (4%), toxic megacolon (3%), pseudomembranous colitis (3%), leukocytosis >=15,000/ul (61%), and/or ICU admission (21%). Four percent required colectomy. Overall, 23% of LTCO cases died within 30 days of hospital admission.


Conclusion: The incidence of CDI in LTCFs averages 2.3 /10,000 patient-days, which represents a third of what has been reported in acute care hospitals. About half of LTCO cases occurred within 30 days after hospital discharge. Recurrent and severe infections were common. Decreasing the burden of CDI in LTCFs should focus on prevention across the continuum of care and on decreasing recurrences by using novel therapies.

Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

Deepa Pawar, MD1, Rebecca Smith, MPH, MLS1, Deborah Nelson, MSN1, Fernanda Lessa, MD2, L. Clifford McDonald, MD2 and Ghinwa Dumyati, MD1, (1)University of Rochester Center for Community Health, Rochester, NY, (2)CDC, Atlanta, GA


D. Pawar, None

R. Smith, None

D. Nelson, None

F. Lessa, None

L. C. McDonald, None

G. Dumyati, None

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