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National estimates of incidence, recurrence, hospitalization, and death of nursing home-onset Clostridium difficile infections United States, 2012

Session: Oral Abstract Session: Clostridium difficile: Epidemiology, Risk Factors, and Impact
Thursday, October 9, 2014: 2:00 PM
Room: The Pennsylvania Convention Center: 109-AB

Nursing home residents are at high risk of Clostridium difficile infection (CDI) due to advanced age and frequent healthcare exposures. However, the national burden of CDI occurring in this setting is not well characterized. We analyzed population-based surveillance data to estimate national incidence, recurrence, hospitalization, and death among patients with onset of CDI in nursing homes.


Population-based CDI surveillance data from 10 U.S. geographic areas, encompassing 348 nursing homes, were used to identify nursing-home onset (NHO) CDI cases, defined as: 1) C. difficile-positive stool by either toxin or molecular assay during 2012 in a surveillance area resident at least one year of age without a positive test in the prior 8 weeks, and 2) C. difficile-positive stool was collected in a nursing home or ≤3 days after hospital admission from a nursing home.  Medical record review was performed on a random sample of cases. A regression model was used to calculate incidence controlling for identified predictors of high NHO-CDI incidence that vary by region.  Sampling weights were used to estimate national burden of infections and numbers of hospitalizations, recurrences and deaths among NHO-CDI cases.


A total of 3,513 NHO-CDI cases were identified. Among 272 cases with full medical record review, median age was 82 years (range: 21–106), 60% were female, 77% received antibiotics in the 12 weeks prior to C.difficile-positive specimen, and 57% were discharged from a hospital in the month prior.  After adjusting for age and diagnostic testing methods, the national estimate for annual NHO-CDI incidence was 115,811 (95% CI: 97,159–134,121) cases. Among NHO-CDI cases nationwide, we estimated that 31,644 were hospitalized within 7 days of positive specimen (95% CI: 25,872–37,415), 21,103 recurred 14–60 days after previous positive specimen (95% CI: 14,720–27,487), and 9,053 died within 30 days (95% CI: 6,874–11,231).


NHO-CDI is associated with substantial morbidity and mortality. Most patients were exposed to antibiotics and had onset of disease within a month after hospital discharge. Strategies to reduce antibiotic use in acute and long-term care settings may lead to decreases in CDI with onset in nursing homes.

Jennifer C. Hunter, DrPH1,2, Yi Mu, PhD1, Ghinwa K. Dumyati, MD, FSHEA3, Monica M. Farley, MD4,5,6, Lisa G. Winston, MD7, Helen L. Johnston, MPH8, James I. Meek, MPH9, Lucy E. Wilson, MD10, Stacy M, Holzbauer, DVM, MPH, DACVPM11,12, Zintars G. Beldavs, MS13, Erin C. Phipps, DVM14, John R. Dunn, DVM, PhD15, Jessica a. Cohen, MPH1,16, Nimalie D. Stone, MD, MS1, L. Clifford Mcdonald, MD, FACP, FSHEA1 and Fernanda C. Lessa, MD1, (1)Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Healthcare Quality Promotion, Atlanta, GA, (2)Centers for Disease Control and Prevention, Division of Scientific Education and Professional Development, Epidemic Intelligence Service, Atlanta, GA, (3)University of Rochester Medical Center, Rochester, NY, (4)Emory University School of Medicine, Atlanta, GA, (5)Medicine/Infectious Diseases, Emory University School of Medicine, Atlanta, GA, (6)Atlanta Veterans Affairs Medical Center, Decatur, GA, (7)University of California, San Francisco, School of Medicine, Department of Medicine, San Francisco, CA, (8)Colorado Department of Public Health and Environment, Denver, CO, (9)Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, CT, (10)Maryland Department of Health and Mental Hygiene, Baltimore, MD, (11)Minnesota Department of Health, St. Paul, MN, (12)11Centers for Disease Control and Prevention, Office of Public Health Preparedness and Response, Career Epidemiology Field Office Program, St. Paul, MN, (13)Acute & Communicable Disease Prevention, Oregon Health Authority, Portland, OR, (14)New Mexico Emerging Infections Program, Albuquerque, NM, (15)Tennessee Department of Health, Nashville, TN, (16)Atlanta Research and Education Foundation, Atlanta, GA


J. C. Hunter, None

Y. Mu, None

G. K. Dumyati, None

M. M. Farley, None

L. G. Winston, None

H. L. Johnston, None

J. I. Meek, CDC Emerging Infections Program: Investigator, Research grant and Salary

L. E. Wilson, None

S. M. Holzbauer, None

Z. G. Beldavs, None

E. C. Phipps, None

J. R. Dunn, None

J. A. Cohen, None

N. D. Stone, None

L. C. Mcdonald, None

F. C. Lessa, None

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