1369. The Epidemiology of Endemic Clostridium difficile Infection (CDI) at an Academic Medical Center: Strain 027, Surveillance Definitions, and Hospital Room Occupancy
Session: Poster Abstract Session: Clostridium difficile
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background:

CDI epidemiology during stable rates of infection was studied using a cohort of all consecutive positive results. We determined the significance of strain 027, the proportions assigned to surveillance categories, and the distribution of hospital-onset (HO) cases by hospital room in order to study whether the spatial distribution suggested a need for enhanced room cleaning.

Methods:

Fletcher Allen Health Care (FAHC) is a 400-bed academic medical center in northern VT. A prospective cohort included all patients with a positive CD stool during 8 months, including outpatients and tests from other facilities. The Cepheid Xpert C. difficile/Epi test was used to identify strain 027. NHSN surveillance categories were assigned and hospital rooms were recorded for 30 days prior to and following the diagnosis.

Results:

218 patients had a positive CD stool during the study. The HO CDI rate was 0.6/1,000 patient-days. For the entire cohort, the median age was 60 and 59% were female. For the 81% for whom a surveillance category could be determined, 31% were HO, 28% were community-onset healthcare facility-associated, and 36% were community-associated (CA). CA cases were more likely to be female than for other combined categories (77% vs. 51%, p < .01), while HO cases were less likely to be female (44% vs. 68%, p < .01). Only 12% of patients had strain 027 and only 7% of FAHC HO cases were 027, compared to 33% of CDIs from 3 community hospitals.  027 cases were not associated with increased severity or mortality, although recurrence was more common (19% vs. 8%). Of the 54 HO cases, 9% were diagnosed in a room that had an active CDI case within 30 days. 35% had been in any room occupied by a patient who had, or eventually developed, CDI within 30 days; the others had no room connection. No 027 HO case had a room link to another 027 case during the study.

Conclusion:

HO cases accounted for only 31% of CDIs that could be categorized – fewer than CA cases. Strain 027 only accounted for 12%, and was more likely to come from community hospitals than from FAHC inpatients. There was no evidence of room clustering of 027 cases and they did not appear to be more severe. Only 9% of cases were diagnosed in a room that had been occupied by a CDI case within 30 days, suggesting a limited role for enhanced terminal room cleaning.

Kensley Nichols, MD, Infectious Diseases, Fletcher Allen Health Care, Burlington, VT, Carolyn Terhune, Infection Prevention, Fletcher Allen Health Care, Burlington, VT and W. Kemper Alston, MD, MPH, Fletcher Allen Health Care, Burlington, VT

Disclosures:

K. Nichols, None

C. Terhune, None

W. K. Alston, None

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