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High Prevalence and Frequent Acquisition of Clostridium difficile Ribotype 002 Among Nursing Home Residents in Hong Kong

Published online by Cambridge University Press:  07 May 2018

Shik Luk
Affiliation:
Department of Pathology, Princess Margaret Hospital, Hong Kong, China
Alex Yat Man Ho
Affiliation:
Department of Pathology, Princess Margaret Hospital, Hong Kong, China
Eliza Hoi Ying Chan
Affiliation:
Infection Control Branch, Centre For Health Protection, Department of Health Hong Kong, China; Infectious Disease Control Training Centre, Hospital Authority, Hong Kong, China
Iris Hoi Ling Tsang
Affiliation:
Infection Control Branch, Centre For Health Protection, Department of Health Hong Kong, China; Infectious Disease Control Training Centre, Hospital Authority, Hong Kong, China
Tak Keung Ng
Affiliation:
Department of Pathology, Princess Margaret Hospital, Hong Kong, China
Wing Kin To
Affiliation:
Department of Pathology, Princess Margaret Hospital, Hong Kong, China
Kin Wing Choi
Affiliation:
Infection Control Branch, Centre For Health Protection, Department of Health Hong Kong, China; Infectious Disease Control Training Centre, Hospital Authority, Hong Kong, China
Andrew Tin Yau Wong
Affiliation:
Infection Control Branch, Centre For Health Protection, Department of Health Hong Kong, China; Infectious Disease Control Training Centre, Hospital Authority, Hong Kong, China
Corresponding
E-mail address:

Abstract

OBJECTIVE

To determine the incidence and risk factors associated with Clostridium difficile colonization among residents of nursing homes and to identify the ribotypes of circulating C. difficile strains.

DESIGN

A prospective cohort study with a follow-up duration of 22 months.

SETTING

Nursing homes.

PARTICIPANTS

Of the 375 residents in 8 nursing homes, 300 residents (80.0%) participated in the study. A further prospective study of 4 nursing homes involving 141 residents with a minimum of 90 days of follow-up was also performed.

METHODS

Baseline and 90-day stool cultures were obtained; additional stool cultures were obtained for residents who had been discharged from hospitals. Polymerase chain reaction (PCR) ribotyping and slpA typing were performed for all C. difficile strains isolated.

RESULTS

Toxigenic C. difficile was isolated in 30 residents (10%) at baseline, and 9 residents (7.3%) had acquired toxigenic C. difficile in the nursing homes. The presence of nasogastric tube was an independent risk factor (adjusted odds ratio, 8.59; 95% confidence interval, 1.18–62.53; P=.034) for C. difficile colonization. The Kaplan-Meier estimate of median carriage duration was 13 weeks. The C. difficile ribotypes most commonly identified were 002 (40.8%), 014 (16.9%), 029 (9.9%), and 053 (8.5%).

CONCLUSIONS

The high incidence of C. difficile colonization and the overrepresentation of C. difficile ribotype 002 confirmed the contribution of nursing home residents to C. difficile transmission across the continuum of care. An infection control program is needed in long-term care.

Infect Control Hosp Epidemiol 2018;782–787

Type
Original Article
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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