Program Schedule

1638
Clostridium difficile Strains Colonizing Long-Term Care Facility (LTCF) Residents are Similar to Strains Causing Infection in both LTCF and Hospital Patients Suggesting a Shared Continuum of Transmission

Session: Poster Abstract Session: Clostridium difficile Infection: Epidemiology, Presentation, Treatment
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC

Background:

Clostridium difficile infection (CDI) is endemic in long-term care facilities (LTCFs).  Asymptomatic residents colonized with toxigenic strains are a potential reservoir for transmission both in LTCFs and affiliated hospitals.   We used restriction endonuclease analysis (REA) to type and compare C. difficile isolates colonizing LTCF residents and infecting both LTCF and hospital patients.

Methods:

Asymptomatic residents were enrolled from the LTCF associated with either Cleveland VA Hospital (n=200) or Hines VA Hospital (n=200) from February 2012 through August 2012.  Cultures for asymptomatic colonization with C. difficile were obtained from the perirectal area on admission and at 2-week intervals during LTCF stay.  All colonizing isolates underwent REA typing. In addition, available isolates causing CDI with onset in either the LTCF or affiliated VA hospital were typed for comparison.

Results:

Four percent of enrolled Hines LTCF residents were colonized with a toxigenic C. difficile strain during the study, most commonly BI 6/8/17, L group, or BM  group (Table).  For hospital- and LTCF-onset Hines CDI isolates, BI 6/8/17 was also the most common group isolated accounting for 33% of cases. Group AL was found only at Hines.  In comparison, 19% of Cleveland LTCF residents were colonized; the predominant groups were BI 6/8/17, BI non-6/8/17, and DQ, a binary toxin positive group not found at Hines (Table).  In Cleveland, the three most common REA groups isolated from both hospital- and LTCF-onset CDI were also the same as those found in colonized LTCF patients (Table). 

Conclusion:

The BI group and specifically BI 6/8/17 remains endemic at both sites.  Although the prevalence of toxigenic C. difficile colonization varied significantly between the two LTCFs, in both sites the predominant colonizing strain(s) were the most common infecting strains in both the LTCF and hospital.  This suggests a shared continuum of transmission between asymptomatic, colonized LTCF residents and both affiliated hospital and LTCF CDI cases. 

TABLE

Hines

Cleveland

REA Group

Colonizing, N=10

No.

Infecting, N=30

No.

Colonizing, N=41

No.

Infecting, N=42

No.

BI 6/8/17

2

10

8

9

BI non-6/8/17

1

3

8

8

BM

2

1

2

0

L

2

0

1

0

DH

1

1

3

1

AL

1

4

0

0

DQ

0

0

7

9

G

0

3

1

2

Y

0

1

3

2

Other groups

0

5

5

4

Non-specific

1

2

3

7

Susan M. Pacheco, MD1,2, Curtis J. Donskey, MD3,4, Matthew Samore, MD5,6, Jeanmarie Mayer, MD6,7, Nimalie Stone, MD8, Carolyn Gould, MD9, L. Clifford Mcdonald, MD, FACP, FSHEA9, Laurica a. Petrella, BS10, Susan Sambol, BS, MT11, Annette Jencson, BS, MT, CIC12, Venkata Sunkesula, MD, MS12 and Dale Gerding, MD13, (1)Edward Hines, Jr. Veterans Affairs Hospital, Hines, IL, (2)Loyola University Chicago, Maywood, IL, (3)Case Western Reserve University, Cleveland, OH, (4)Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, (5)Medicine, University of Utah School of Medicine, Division of Epidemiology, Salt Lake City, UT, (6)Ideas Center, VA Salt Lake City Health Care System, Salt Lake City, UT, (7)University of Utah School of Medicine, Salt Lake City, UT, (8)Centers for Disease Control and Prevention (CDC), Atlanta, GA, (9)CDC, Atlanta, GA, (10)Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, (11)Hines VA Medical Center, Hines, IL, (12)Louis Stokes Cleveland VA Medical Center, Cleveland, OH, (13)Loyola University and Hines VA Hospital, Hines, IL

Disclosures:

S. M. Pacheco, CDC : Investigator on another investigators grant, Research support

C. J. Donskey, None

M. Samore, None

J. Mayer, None

N. Stone, None

C. Gould, None

L. C. Mcdonald, None

L. A. Petrella, None

S. Sambol, None

A. Jencson, None

V. Sunkesula, None

D. Gerding, Sanofi Pasteur: Board Member, Consulting fee
Actellion: Board Member, Consulting fee
Merck: Board Member, Consulting fee
Rebiotix: Board Member, Consulting fee
Viropharma: Consultant, Consulting fee
Summit: Consultant, Consulting fee
Viropharma: patent holder, patent

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