1276. Longitudinal Trends of Clostridium difficile infection (CDI) within Department of Veterans Affairs (VA) Medical Centers—Acute Care and Long Term Care
Session: Poster Abstract Session: HAI: C. difficile Epidemiology, Impact, and Testing
Friday, October 6, 2017
Room: Poster Hall CD

Background:  CDI remains a significant and serious healthcare-associated infection within hospital and long-term care (LTC) settings.   In 2012 VA began a CDI Prevention Initiative in its acute care (AC) facilities, which expanded to include LTC.  Data were collected with regard to CDI cases and healthcare-facility associated (HCFA) status.  

Methods:  VA used CDC National Healthcare Safety Network (NHSN) Lab-ID Event definitions from CDI/MDRO Module with the exception that HCFA-status was called with a more stringent timeframe at 48 hours after admission.  Monthly, VA Medical Centers and LTC Facilities report data to a central repository which includes number of cases meeting NHSN definitions for recurrence, hospital onset HCFA (HO-HCFA), community-onset HCFA (CO-HCFA) and community onset non HCFA (CO-notHCFA) cases (equivalent of NSHN community-acquired [CA] cases).  Data collection began from 2011 forward in AC, and from part of 2012 forward in LTC.  

Results:  In AC, the number of all cases reported ranged from 6313 to 6595 with no trend for increase/decrease noted from 2011 to 2016.  However, when evaluating proportions of each type of CDI contributing to the overall occurrence, there is significant change over the years (p<0.0001, Chi-Square analysis of proportions) with HO-HCFA and CO-HCFA contributing to less (24.4%  and 25.2%, decreases, respectively) and CO cases (particularly CO-notHCFA) contributing to more (38.1% increase) of the cases, (Fig 1).  In LTC, there were overall lesser cases ranging from 980 to 789 from 2013 through 2016 (p=0.05, linear regression), with no significant changes over the years (p=0.06, Chi-Square of proportions) (Fig 2). 

Conclusion:   Over time, HO-HCFA and CO-HCFA cases have declined within VA AC facilities. However, an increase of CO-notHCFA cases (similar to NHSN CA cases) has occurred, increasing admission prevalence of CDI at VA facilities.  As CDI prevalence on admission is a contributor to risk for HCFA disease, this increased pressure indicates the success of the VA CDI Prevention Initiative in decreases of HO-HCFA is even more substantive than raw rates would indicate.  However, it also highlights a group of CDI cases which need a different, focused targeting of prevention strategies.  

Stephen Kralovic, MD, MPH, FSHEA1,2,3, Martin Evans, MD, FIDSA, FSHEA1,4,5, Loretta Simbartl, MS1 and Gary Roselle, MD, FIDSA1,2,3, (1)National Infectious Diseases Service, Department of Veterans Affairs, Washington, DC, (2)Internal Medicine/Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati, OH, (3)Cincinnati Veterans Affairs Medical Center, Cincinnati, OH, (4)Division of Infectious Diseases, Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY, (5)Lexington Veterans Affairs Medical Center, Lexington, KY


S. Kralovic, None

M. Evans, None

L. Simbartl, None

G. Roselle, None

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