1414. Colonization with C. difficile in Long-term Care Facility Residents in Two Veterans Affairs Community Living Centers
Session: Poster Abstract Session: Clostridium difficile
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C

Clostridium difficile infection (CDI) is endemic in long-term care facilities (LTCFs).  In non-outbreak situations, asymptomatic colonization rates range from 4 to 20% with acquisition occurring in either the hospital or the LTCF.  Patients with a recent history of CDI may shed C. difficile spores for several weeks after treatment, potentially serving as a reservoir for transmission.  We studied the epidemiology of C. difficile colonization in two VA LTCFs.


Four hundred total asymptomatic residents were enrolled from two LTCFs associated with Cleveland VA Medical Center and Hines VA Hospital from February 2012 through September 2012.  Cultures for C. difficile were obtained from rectal, groin, skin, and environmental sites on admission and subsequently at two week intervals for the duration of residency in the LTCF.


Of 400 enrolled residents, 98% were male with an average age of 70.2 years.  An average of 2.6 sets of cultures per resident were obtained.  Overall, 68 residents (17%) were colonized with C. difficile during the study period; 45 were colonized at enrollment, representing 11% of all residents enrolled and 66% of all residents colonized at any point during the study.  31% of those with rectal colonization had simultaneous skin and/or groin colonization.  Environmental cultures were concurrently positive in 27%.  With the exception of environmental sites, C. difficile colonization differed significantly between the two LTCFs (Table).  Of residents who reported a recent history of CDI, 50% had at least one positive culture for C. difficile during the study period. 



Total (%)

Cleveland (%)

Hines (%)







Any C. difficile rectal colonization

68 (17)

54 (27)

14 (7)


C. difficile rectal colonization on enrollment

45 (11)

37 (19)

8 (4)


Concurrent skin or groin colonization

21 (31)

13 (24)

8 (57)


Concurrent positive environmental culture

18 (27)

14 (26)

4 (29)



C. difficile colonization in LTCFs is common and may be acquired in both acute and long-term care settings.   Colonization rates vary significantly between sites and further research is needed in order to determine factors which may affect transmission, including the potential role of patients with a recent history of CDI.

Susan M. Pacheco, MD1,2, Curtis J. Donskey, MD3,4, Matthew Samore, MD5,6, Jeanmarie Mayer, MD5,6, Nimalie D. Stone, MD, MS7, Carolyn V. Gould, MD, MS7, L. Clifford Mcdonald, MD7, Laurica A. Petrella, BS1, Susan Sambol, MT1, Annette Jencson, BSMT(ASCP)SM, CIC3, Deborah Terry1, Venkata C.K. Sunkesula, M.D., M.S3,4 and Dale N. Gerding, MD1,2, (1)Edward Hines, Jr. Veterans Affairs Hospital, Hines, IL, (2)Loyola University Chicago, Maywood, IL, (3)Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, (4)Case Western Reserve University, Cleveland, OH, (5)University of Utah School of Medicine, Salt Lake City, UT, (6)IDEAS Center, VA Salt Lake City Health Care System, Salt Lake City, UT, (7)Centers for Disease Control and Prevention, Atlanta, GA


S. M. Pacheco, CDC: Grant Investigator, Research grant

C. J. Donskey, None

M. Samore, None

J. Mayer, None

N. D. Stone, None

C. V. Gould, None

L. C. Mcdonald, None

L. A. Petrella, None

S. Sambol, None

A. Jencson, None

D. Terry, None

V. C. K. Sunkesula, None

D. N. Gerding, None

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