2085. The Interplay Between Acute and Long-Term Care C. difficile Incidence in the United States Veterans Health Administration: A Retrospective Cohort Study of 169 Facilities
Session: Poster Abstract Session: Clostridium difficile: Outcomes, Testing, Prevention
Saturday, October 29, 2016
Room: Poster Hall
Background: Although most acute and long-term care facilities in the same region are coupled by patient sharing and many experience high rates of C. difficile infection (CDI), the inter-facility spread of C. difficileis understudied. Our objective was to consider the determinants of CDI incidence across acute care (AC) and long term care (LTC) facilities, with a specific interest in the role of patient sharing.

Methods: We conducted a retrospective cohort study of CDI from 2006-2012 across the Veterans Affairs Healthcare System. Our outcome was defined as a health-care-associated lab-identified C. difficileevent, defined as a positive lab test in a patient having at least 3 days of facility exposure in the prior 8 weeks, and occurring at least 8 weeks from a previous positive test. Individual-level risk variables included (1) age, (2) antibiotic use, and history of (3) acute or (4) long-term care stay in the prior 56 days. Facility-level predictors included (1) antibiotic use (days with therapy per 1,000 person-days), the proportion of persons with an (2) acute or (3) long-term care stay in prior 56 days, and importation of CDI cases from (4) acute or (5) long-term care per 10 000 person-days.

Results: 87 LTC and 82 AC facilities met our inclusion criteria. The incidence of CDI in LTC was 3.8 per 10,000 patient-days (n=6,766 cases) and was 17.9 per 10,000 patient-days (n=26,113 cases) in AC. LTC patients with a recent AC stay were more likely to develop CDI than those without a recent AC stay (IRR=4.81, 95%CI: 4.56, 5.07). Similarly, AC patients with a recent LTC stay were also more likely to develop CDI than those without, but to a lesser degree (IRR=1.88, 95%CI: 1.79, 1.98). Imported CDI cases were more prevalent in LTC (median=75 per 10,000 patient-days, range: 1.5-355) compared to AC (median=39, range: 0-115, p<0.001). In bivariate weighted linear regression models, importation of AC cases was a strong predictor of increased CDI incidence in LTC (R2=0.62), but importation of cases from LTC was not as strong a predictor of AC rates (R2=0.21).

Conclusion: Acute care and long-term care facilities are both impacted by importation of CDI. This research suggests that improved regional communication, and an inter-facility, coordinated approach to infection control, could help reduce CDI spread.

Kevin Brown, PhD, Infection Prevention and Control, Public Health Ontario, Toronto, ON, Canada and Matthew Samore, MD, FSHEA, University of Utah School of Medicine, Division of Epidemiology, Salt Lake City, UT


K. Brown, None

M. Samore, None

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