1358. Community-Acquired Clostridium difficile Infection is more common than Hospital-Onset in Hospitalized Patients A Two-Year Retrospective Study
Session: Poster Abstract Session: Clostridium difficile
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Abstract40684.png (232.8 kB)
  • Background:

    Hospital-Onset Clostridium difficile Infections (HO-CDI) are a major focus for infection prevention in the United States.  Little data exists on the relationship between Community Onset Clostridium difficile Infections (CO-CDI) and HO-CDI.  Preventing Clostridium difficileinfection (CDI) in the Community has been overlooked. This study will outline the importance of CO-CDI rates and its impact on the HO-CDI rates.

    Methods:

    This was a retrospective study of all 158 CDI admitted to Kaiser Foundation Hospital, Fresno, California in 2011 and 2012.  CO- CDI was diagnosed when a patient had unexplained diarrhea and a positive stool test for CDI within 72 hours after admission. Patients that were admitted whose stool tested positive but were in the hospital within the previous 4 weeks were defined as Community-onset healthcare-associated CDI (CO-HA-CDI).  In the Initial 4 months of the study (18% of the cases [29 of 158]), we utilized Enzyme Immunoassay (EIA) to detect toxins for diagnosis. For the remaining cases (82% of the cases [129 of 158]), we used EIA to detect Glutamate Dehydrogenase and confirmed toxins by Polymerase Chain Reaction. We also reviewed antibiotics, proton pump inhibitors (PPIs) and H2 Blockers prescribed within 30 days prior to CDI for all 158 cases.

    Results:

    Out of all patients admitted to the hospital with CDI: 60% (n=95 of 158) were identified as CO-CDI; 23% were HO-CDI; 17% CO-HA-CDI.  During the beginning of this study period, 9% (n=14 of 158) of the CDI could have been identified as CO-CDI had the testing been timely. The incidence of CO-CDI increased 14% from 2011 (n=45 of 158) to 2012 (n=50 of 158).

    Among CO-CDI cases, 73% received antibiotics, 32% H2 Blockers, and 25% PPIs within 30 days prior to CDI. For HO-CDI cases, 94% received antibiotics, 58% H2 Blockers, and 44% PPIs. For CO-HA-CDI cases, 95% received antibiotics, 63% H2 Blockers, and 58% PPIs.

    Conclusion:

    Incidence of CO-CDI in hospital is more significant than generally appreciated. Importance of CO-CDI should not be overlooked in the effort to reduce HO-CDI infections. H2 blockers are more significantly involved in all CO-CDI, HO-CDI and CO-HA-CDI cases compared to PPIs. More research is needed to truly identify the impact of CO-CDI on Hospital Rates and the role of H2 blockers in CDI.

    Harold Lin, MD, MS1,2, Raed Khoury, MA, MPH3, Thomas Lam, MD4, Hishida Kurt, BSN, CIC3, Krickett Pal, RN3, Elisa Porter, BA3 and Dee Lacy, MD, Ph.D1, (1)Infectious Diseases, Kaiser Permanente Medical Group, Fresno, Fresno, CA, (2)Infectious Diseases, University of California, San Francisco, Fresno, School of Medicine, Fresno, CA, (3)Infection Prevention and Control, Kaiser Foundation Hospital, Fresno, Fresno, CA, (4)Hospital Medicine Department, Kaiser Permanente Medical Group, Fresno, Fresno, CA

    Disclosures:

    H. Lin, None

    R. Khoury, None

    T. Lam, None

    H. Kurt, None

    K. Pal, None

    E. Porter, None

    D. Lacy, None

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