1402. The Epidemiology of Clostridium difficile Infection (CDI) in Patients with Frequent Interfacility Transfers
Session: Poster Abstract Session: Clostridium difficile
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • IDSA_OPTIMER_Awali.pdf (1.1 MB)
  • Background:

    Patients with frequent inter-facility transfers (IFTs) between various health care facilities including acute care hospitals, long-term acute care facilities (LTACHs) and skilled nursing facilities (SNFs) are at increased risk of acquiring Clostridium difficile Infection (CDI).


    A prospective study was conducted between Oct 2012 and Apr 2013 on patients diagnosed with CDI using a nucleic acid amplification test (NAAT) at a tertiary care hospital in Detroit. Medical records were reviewed for patient demographics, co-morbidities, previous hospitalizations and use of antibiotics in the 60 days prior to CDI. Patients were then followed by monthly telephone interviews. LTACHs and SNFs, where patients were transferred were contacted to collect information about episodes of diarrhea, use of antibiotics and recurrent CDI. Recurrent CDI was defined as return of diarrhea and positive NAAT for CDI within 8 weeks of initial diagnosis after documented symptom resolution. Statistical analyses were conducted using SAS version 9.3.


    Mean age of the cohort (N=81) was 58 ± 20 years, 65% were African- Americans and 59% were men. Forty four patients (54%) acquired CDI after 48 hours of admission. Thirty eight patients (48%) had history of at least one prior hospitalization and prior use of 2 or more antibiotics was noted in 59 patients (73%).

    The median IFTs for CDI patients was 2 (Interquartile range {IQR} = 2 – 4) while that for recurrent CDI patients was 3 (IQR = 2 – 6). Median length of stay at the acute hospital was 9 days (IQR = 5 – 23). The median time from diagnosis to resolution of diarrhea was 17 days (IQR = 5 – 30) with 20% patients reporting persistence of diarrhea even 7 days after discharge. Twenty two patients were discharged directly to SNFs or LTACHs. Eight patients (13%) had recurrent CDI, 2 of them being SNF residents. Factors associated with recurrences included treatment of the first episode of CDI with metronidazole (50%) and concomitant use of antibiotics (50%). The six-month all-causes mortality was 0.5 %( n=4).


    With the recent implementation of the accountable care organizations and the frequent IFTs of patients, it is critical to develop standard policies for antibiotic stewardship and infection prevention across the entire health care system.

    Reda Awali, MD, MPH, Vallabh Karpe, MD, Bharat Marwaha, MD, Muhammad Bilal Asghar, MD, Fatima Motiwala, MD, Amina Pervaiz, MD, Urooj Qazi, MD, Ranbir Singh, MD, Sravya Dasyam, MD, Tejasvi Sunkara, MD and Teena Chopra, MD, MPH, Infectious Diseases, Detroit Medical Center/ Wayne State University, Detroit, MI


    R. Awali, None

    V. Karpe, None

    B. Marwaha, None

    M. B. Asghar, None

    F. Motiwala, None

    A. Pervaiz, None

    U. Qazi, None

    R. Singh, None

    S. Dasyam, None

    T. Sunkara, 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.