Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-09T14:30:32.540Z Has data issue: false hasContentIssue false
  • English
  • Français

Clostridium difficile in an Urban, University-Affiliated Long-Term Acute-Care Hospital

Published online by Cambridge University Press:  07 December 2016

Jerry Jacob ,
Jingwei Wu ,
Jennifer Han  and
Deborah B. Nelson
Jerry Jacob*
Affiliation:
Department of Medicine, Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Jingwei Wu
Affiliation:
Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, Pennsylvania
Jennifer Han
Affiliation:
Department of Medicine, Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Deborah B. Nelson
Affiliation:
Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, Pennsylvania
*
Address correspondence to Dr Jerry Jacob, Good Shepherd Penn Partners, 1800 Lombard St, Philadelphia, PA 19146 (jerry.jacob@uphs.upenn.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVES

To describe the characteristics and impact of Clostridium difficile infection (CDI) in a long-term acute-care hospital (LTACH).

DESIGN

Retrospective matched cohort study.

SETTING

A 38-bed, urban, university-affiliated LTACH.

METHODS

The characteristics of LTACH-onset CDI were assessed among patients hospitalized between July 2008 and October 2015. Patients with CDI were matched to concurrently hospitalized patients without a diagnosis of CDI. Severe CDI was defined as CDI with 2 or more of the following criteria: age ≥65 years, serum creatinine ≥2 mg/dL, or peripheral leukocyte count ≥20,000 cells/μL. A conditional Poisson regression model was developed to determine characteristics associated with a composite primary outcome of 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 age of 70 years (SD, 14 years), a mean Charlson comorbidity index of 3.6 (SD, 2.0), a median length of stay of 33 days (interquartile range [IQR], 24–45 days), and a median time between admission and CDI diagnosis of 16 days (IQR, 9–23 days). The most commonly prescribed antibiotic preceding a CDI diagnosis was a cephalosporin, with median duration of 8 days (IQR, 4–14 days). In multivariate analysis, CDI was not significantly associated with the primary outcome (relative risk, 0.97; 95% CI, 0.59–1.58).

CONCLUSIONS

Incidence of CDI in an urban, university-affiliated LTACH was high. Future research should focus on infection prevention measures to decrease the burden of CDI in this complex patient population.

Infect Control Hosp Epidemiol 2017;38:294–299

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 3 , March 2017 , pp. 294 - 299
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

a

Authors of equal contribution.

References

REFERENCES

1. Magill, SS, Edwards, JR, Bamberg, W, et al. Multistate point-prevalence survey of health care–associated infections. N Engl J Med 2014;370:1198–1208.CrossRefGoogle ScholarPubMed
2. Lofgren, ET, Cole, SR, Weber, DJ, Anderson, DJ, Moehring, RW. Hospital-acquired Clostridium difficile infections: estimating all-cause mortality and length of stay. Epidemiology 2014;25:570–575.Google Scholar
3. Guerrero, DM, Nerandzic, MM, Jury, LA, Chang, S, Jump, RL, Donskey, CJ. Clostridium difficile infection in a Department of Veterans’ Affairs long-term care facility. Infect Control Hosp Epidemiol 2011;32:513–515.CrossRefGoogle Scholar
4. Simor, AE, Yake, SL, Tsimidis, K. Infection due to Clostridium difficile among elderly residents of a long-term-care facility. Clin Infect Dis 1993;17:672–678.Google Scholar
5. Ziakas, PD, Zacharioudakis, IM, Zervou, FN, Grigoras, C, Pliakos, EE, Mylonakis, E. Asymptomatic carriers of toxigenic C. difficile in long-term care facilities: a meta-analysis of prevalence and risk factors. PloS One 2015;10:e0117195.CrossRefGoogle ScholarPubMed
6. Gould, CV, Rothenberg, R, Steinberg, JP. Antibiotic resistance in long-term acute care hospitals: the perfect storm. Infect Control Hosp Epidemiol 2006;27:920–925.Google Scholar
7. Goldstein, EJC, Polonsky, J, Touzani, M, Citron, DM. C. difficile infection (CDI) in a long-term acute care facility (LTAC). Anaerobe 2009;15:241–243.Google Scholar
8. Brakovich, B, Bonham, E, VanBrackle, L. War on the spore: Clostridium difficile disease among patients in a long-term acute care hospital. J Healthcare Qual 2013;35:15–21.Google Scholar
9. Miller, R, Simmons, S, Dale, C, Stachowiak, J, Stibich, M. Utilization and impact of a pulsed-xenon ultraviolet room disinfection system and multidisciplinary care team on Clostridium difficile in a long-term acute care facility. Am J Infect Control 2015;43:1350–1353.Google Scholar
10. National Healthcare Safety Network. Multidrug-resistant organism and Clostridium difficile infection module. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/pdfs/pscmanual/12pscmdro_cdadcurrent.pdf. Updated May 2016. Accessed Jun 17, 2016.Google Scholar
11. Na, X, Martin, AJ, Sethi, S, et al. A multi-center prospective derivation and validation of a clinical prediction tool for severe Clostridium difficile infection. PloS One 2015;10:e0123405.Google Scholar
12. Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–383.Google Scholar
13. Cummings, P, Mcknight, Barbara. Analysis of matched cohort data. Stata J 2004;4:274–281.CrossRefGoogle Scholar
14. McDonald, LC, Lessa, F, Sievert, D, et al. Vital signs: preventing Clostridium difficile infections. MMWR 2012;61:157–162.Google Scholar
15. Fridkin, S, Baggs, J, Fagan, R, et al. Vital signs: improving antibiotic use among hospitalized patients. MMWR Morb Mortal Wkly Rep 2014;63:194–200.Google Scholar
16. Chopra, T, Goldstein, EJC. Clostridium difficile infection in long-term care facilities: a call to action for antimicrobial stewardship. Clin Infect Dis 2015;60:S72–S76.Google Scholar
17. Mylotte, JM. Surveillance for Clostridium difficile-associated diarrhea in long-term care facilities: what you get is not what you see. Infect Control Hosp Epidemiol 2008;29:760–763.Google Scholar
18. Hensgens, MPM, Goorhuis, A, Dekkers, OM, van Benthem, BHB, Kuijper, EJ. All-cause and disease-specific mortality in hospitalized patients with Clostridium difficile infection: a multicenter cohort study. Clin Infect Dis 2013;56:1108–1116.Google Scholar
19. Lessa, FC, Mu, Y, Bamberg, WM, et al. Burden of Clostridium difficile infection in the United States. N Engl J Med 2015;372:825–834.CrossRefGoogle ScholarPubMed
20. Tabak, YP, Johannes, RS, Sun, X, Nunez, CM, McDonald, LC. Predicting the risk for hospital-onset Clostridium difficile infection (HO-CDI) at the time of inpatient admission: HO-CDI risk score. Infect Control Hosp Epidemiol 2015;36:695–701.Google Scholar
21. Khanna, S, Pardi, DS, Aronson, SL, et al. The epidemiology of community-acquired Clostridium difficile infection: a population-based study. Am J Gastroenterol 2012;107:89–95.CrossRefGoogle ScholarPubMed