Program Schedule

A Tale of Two States: An Exploration of Disparities in the Proportion of Long-term Care Facility--onset Clostridium difficile Infections in Minnesota and New Mexico

Session: Poster Abstract Session: Clostridium difficile Infection: Epidemiology, Presentation, Treatment
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
  • IDWeek_Holzbauer.pdf (301.2 kB)
  • Background: Long-term care facility (LTCF) residents are at higher risk for developing Clostridium difficileinfections (CDI). Both Minnesota (MN) and New Mexico (NM) perform active population-based surveillance for CDI in select counties. While both states have historically similar overall CDI incidence rates, the proportion of LTCF-onset CDI is much higher in NM. We compared surveillance data from the two states to identify differences.

    Methods: We analyzed population-based CDI data from January 1, 2011– September 30, 2013. A CDI case was defined as a stool specimen positive for C. difficile obtained from a patient without a C. difficile-positive specimen in the previous 8 weeks. A CDI case was classified as LTCF-onset if positive stool specimen was collected in a LTCF or within 3 days after hospital admission from a LTCF. A medical record review was performed on all LTCF-onset CDI cases in MN and a 10% random sample in NM. LTCF utilization data was obtained from the 2012 Area Resource File. Chi-square test was used for comparisons across the two states.

    Results: A total of 1597 and 3289 CDI cases were identified in MN and NM, respectively. Among all CDI cases, MN cases were less likely to be LTCF-onset (6% vs. 26%; p<0.0001). Among cases with full review, no differences were detected between MN and NM in mean age (80 vs. 77 years; p=0.1), recent H2 receptor antagonist (18% vs. 22%; p=0.6), proton pump inhibiter (53% vs. 48%; p=0.6), or antibiotic usage (71% vs. 77%; p=0.4) in the 12 weeks prior to stool collection. MN LTCF-onset cases were more likely to have a positive test as a hospital inpatient (34% vs. 18%; p=0.02). Among persons greater than 65 years, LTCF utilization was higher in MN than NM (5.7% vs 2.9%, p<0.0001) and MN had significantly higher population rate of LTCFs (47 vs. 25 per 100,000 persons; p<0.0001) and LTCF beds (2235 vs. 2832 per 100,000 persons; p<0.0001).

    Conclusion: Despite LTCF utilization being higher in MN, this state had a lower proportion of LTCF-onset CDI cases compared to NM. No differences in age or prior use of antibiotics or acid reducing medications were detected between LTCF-onset cases in the two states.  Further exploration of the variability in testing and infection control practices in LTCFs is warranted to identify prevention strategies directed to this patient population.

    Stacy M. Holzbauer, DVM, MPH1,2, Tory Whitten, MPH2 and Erin C. Phipps, DVM3, (1)Field Services Branch, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, (2)Minnesota Department of Health, Saint Paul, MN, (3)New Mexico Emerging Infections Program, Albuquerque, NM


    S. M. Holzbauer, None

    T. Whitten, None

    E. C. Phipps, None

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