2069. Clostridium difficile in an Urban, University-Affiliated LTACH
Session: Poster Abstract Session: Clostridium difficile: Epidemiology
Saturday, October 29, 2016
Room: Poster Hall
  • IDweek Poster_2.pdf (2.2 MB)
  • Background: Clostridium difficile is the most common cause of healthcare-associated infections in the United States, and has been associated with adverse outcomes in the acute care setting. However, little is known regarding the burden or impact of C. difficile infection (CDI) in long-term acute care hospitals (LTACHs).

    Methods: A retrospective matched cohort study was performed among patients at an urban, university-affiliated LTACH between July 2008 and October 2015. The incidence rate of LTACH-onset CDI was assessed and patient characteristics associated with adverse outcomes examined. Patients with CDI were matched to concurrently hospitalized LTACH patients without a diagnosis of CDI. A multivariable model using conditional Poisson regression was developed to determine characteristics associated with a composite primary outcome of either 30-day readmission to an acute care hospital or mortality.

    Results: The overall incidence of CDI was 21.4 cases per 10,000 patient-days, with 27% of infections classified as severe. Patients with CDI had a mean (±SD) age of 70 ±14 years, a mean admission Charlson Comorbidity Index of 4 ±2, and a median (IQR) length of stay of 33 (24-46) days. Median time between admission and diagnosis of CDI was 16 (9-23) days. No significant difference was found in the rate of the primary outcome between the matched CDI and non-CDI groups (38% vs 36%, respectively; P=0.82). In the final multivariable analysis, increased creatinine trended towards an increased risk for the primary outcome (RR, 1.30 [95% confidence interval, 0.98-1.73]).

    Conclusion: LTACH-onset CDI was found to have a relatively high incidence in an urban, university affiliated LTACH. CDI was not a significant risk factor for the composite outcome of 30-day readmission or mortality. Future research should focus on infection prevention and antibiotic stewardship measures to decrease CDI specifically in the LTACH setting.

    Jerry Jacob, MD1, Jingwei Wu, PhD2, Jennifer Han, MD, MSCE3 and Deborah Nelson, PhD2, (1)Division of Infectious Diseases, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, (2)Epidemiology and Biostatistics, Temple University, College of Public Health, Philadelphia, PA, (3)Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA


    J. Jacob, None

    J. Wu, None

    J. Han, None

    D. Nelson, None

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