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Transmission of Clostridium difficile from asymptomatically colonized or infected long-term care facility residents

Published online by Cambridge University Press:  31 May 2018

Curtis J. Donskey*
Affiliation:
Geriatric ResearchEducationand Clinical Center, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
Venkata C. K. Sunkesula
Affiliation:
Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
Nimalie D. Stone
Affiliation:
Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Healthcare Quality Promotion, Atlanta, Georgia
Carolyn V. Gould
Affiliation:
Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Healthcare Quality Promotion, Atlanta, Georgia
L. Clifford McDonald
Affiliation:
Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Healthcare Quality Promotion, Atlanta, Georgia
Matthew Samore
Affiliation:
University of Utah School of Medicine, Division of Epidemiology, Salt Lake City, Utah
JeanMarie Mayer
Affiliation:
University of Utah School of Medicine, Salt Lake City, Utah
Susan M. Pacheco
Affiliation:
University of Utah School of Medicine, Salt Lake City, Utah
Annette L. Jencson
Affiliation:
Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
Susan P. Sambol
Affiliation:
University of Utah School of Medicine, Salt Lake City, Utah
Laurica A. Petrella
Affiliation:
Edward Hines, Jr Veterans Affairs Hospital, Hines, Illinois
Christopher A. Gulvik
Affiliation:
Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Healthcare Quality Promotion, Atlanta, Georgia
Dale N. Gerding
Affiliation:
Edward Hines, Jr Veterans Affairs Hospital, Hines, Illinois Loyola University, Chicago Stritch School of Medicine, Maywood, Illinois
*
Author for correspondence: Curtis J. Donskey, MD, Geriatric Research Education and Clinical Center, Louis Stokes Veterans Affairs Medical Center, 10701 East Blvd., Cleveland, OH, 44106. E-mail: Curtis.Donskey@va.gov

Abstract

Objective

To test the hypothesis that long-term care facility (LTCF) residents with Clostridium difficile infection (CDI) or asymptomatic carriage of toxigenic strains are an important source of transmission in the LTCF and in the hospital during acute-care admissions.

Design

A 6-month cohort study with identification of transmission events was conducted based on tracking of patient movement combined with restriction endonuclease analysis (REA) and whole-genome sequencing (WGS).

Setting

Veterans Affairs hospital and affiliated LTCF.

Participants

The study included 29 LTCF residents identified as asymptomatic carriers of toxigenic C. difficile based on every other week perirectal screening and 37 healthcare facility-associated CDI cases (ie, diagnosis >3 days after admission or within 4 weeks of discharge to the community), including 26 hospital-associated and 11 LTCF-associated cases.

Results

Of the 37 CDI cases, 7 (18·9%) were linked to LTCF residents with LTCF-associated CDI or asymptomatic carriage, including 3 of 26 hospital-associated CDI cases (11·5%) and 4 of 11 LTCF-associated cases (36·4%). Of the 7 transmissions linked to LTCF residents, 5 (71·4%) were linked to asymptomatic carriers versus 2 (28·6%) to CDI cases, and all involved transmission of epidemic BI/NAP1/027 strains. No incident hospital-associated CDI cases were linked to other hospital-associated CDI cases.

Conclusions

Our findings suggest that LTCF residents with asymptomatic carriage of C. difficile or CDI contribute to transmission both in the LTCF and in the affiliated hospital during acute-care admissions. Greater emphasis on infection control measures and antimicrobial stewardship in LTCFs is needed, and these efforts should focus on LTCF residents during hospital admissions.

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

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