1362. Positive Clostridium difficile Tests Underestimate C. difficile Infections in Four Veterans Affairs Long-Term Care Facilities
Session: Poster Abstract Session: Clostridium difficile
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C

Background:   The burden of C. difficile infections in long-term care facilities is difficult to quantify.  Acute care hospitals use ICD-9 codes to estimate C. difficile infection rates but this measure is not readily applied in long-term care facilities.  Instead, long-term care facilities may rely on positive C. difficile tests to estimate the burden of C. difficile infection, which may not be accurate.  Our objective was to compare rates of positive C. difficile tests with the prevalence of actual C. difficile infections at long-term care facilities.

Methods: We used structured query language (SQL) to collect data on a retrospective cohort of patients admitted to the 4 long-term care facilities within the Veterans Integrated Service Network 10 (VISN 10) between 2009 and 2010.  To determine the rate of positive C. difficile tests among LTCF residents, we calculated the number of positive C. difficile tests per month.  To determine the prevalence C. difficile infection among the long-term care facility residents, we used an algorithmic approach evaluating C. difficile test outcomes and administration of metronidazole or oral vancomcycin combined with electronic medical record review to calculate the number of C. difficile infections per month.

Results:   Between 2009 and 2010, the average number of positive C. difficile tests per month was 5.8 2.6 compared to 8.2 3.7 cases of C. difficile infection per month (P = 0.01).  Compared to those without, residents with C. difficile infection had a longer length of stay (130 vs. 63 days, P < 0.0001).  Otherwise, the two populations were similar.

Conclusion:   In 4 Veterans Affairs (VA) long-term care facilities, positive C. difficile tests underestimate the prevalence of C. difficile infections.  This has implications for infection control measures within long-term care facilities.  These results may also influence interpretation of national surveillance data used to estimate the burden of C. difficile infection in long-term care facilities.

Alison Han, MD, MS, Medicine, University Hospitals Case Medical Center, Cleveland, OH and Robin Jump, M.D., Ph.D, Department of Medicine, Case Western Reserve University, Cleveland, OH; Division of Infectious Diseases and HIV Medicine, Case Western Reserve University, Cleveland, OH; Geriatric Research Education and Clinical Center (GRECC), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH


A. Han, None

R. Jump, None

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