1366. Clostridium difficile at Long Term Care Facilities-Are We Testing  Enough?
Session: Poster Abstract Session: Clostridium difficile
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • IDSA_CDI_Testing_Pervaiz.pdf (776.9 kB)
  • Background:

    Clostridium difficile (CD) is the most common cause of diarrhea in a long term care facilities (LTCFs).However there is scant data pertaining to true prevalence of Clostridium difficileInfection (CDI) in LTCFs. 


    Detroit Medical Center is a tertiary care center in metropolitan Detroit  with a centralized Microbiology Laboratory that receives stool samples to diagnose CDI from :1)Acute Hospitals[Total bed count=1200], 2) Sixteen Long term care facilities(LTCFs)[Median bed count =  115 beds (Interquartile range =40-169)], and  3)Outpatient clinics   . Microbiology data of all patients who received NAAT for CD was assessed to compute and compare the prevalence of CDI at various health care facilities from Jan 2011 through Jan 2013.


    LTCFs had the highest prevalence of CDI at 31.2 %( Total NAATs performed [TN] =1031, average of 2 tests/month per facility), followed by acute care hospitals at 15% (TN=13, 970, average of 50-100 tests/month) and outpatient clinics at 12.8% (TN=1091). One of the LTCF with 40 hospital beds had a surprisingly low prevalence of 13.1 %( TN=654, average of 26 tests/month).Of note this LTCF was physically located at an acute care hospital and was managed by the same staff as the acute care hospital.


    Despite the low testing volumes for CDI at LTCFs, their CDI prevalence was 2-fold higher as compared to acute hospitals. However, the LTCF supervised by the acute hospital staff reflected a low CDI prevalence .This calls for a critical need for educating health care workers including nurses, nurse practitioners, nurse aids and physicians at LTCFs to send diarrheal stool for CDI testing. Early diagnosis can help decrease CDI related morbidity and mortality and transmission opportunities in older adults at LTCFs.

    Amina Pervaiz, MD1, Paul Lephart, PhD2, Theodore Theodoroff3, Reda A. Awali, MD, MPH4, Keith Kaye, MD, MPH, FIDSA, FSHEA1 and Teena Chopra, MD, MPH5, (1)Infectious Diseases, Detroit Medical Center/ Wayne State University, Detroit, MI, (2)Detroit Medical Center University Laboratories, Detroit, MI, (3)Detroit Medical Center, Detroit, MI, (4)Detroit Medical Center, Wayne State University, Detroit, MI, (5)Internal Medicine/Infectious Diseases, Detroit Medical Center/Wayne State University, Detroit, MI


    A. Pervaiz, None

    P. Lephart, None

    T. Theodoroff, None

    R. A. Awali, None

    K. Kaye, None

    T. Chopra, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.