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The use of laboratory-identified event surveillance to classify adverse outcomes due to Clostridioides difficile infection in Canadian long-term care facilities

Published online by Cambridge University Press:  23 November 2020

Ye Shen
Affiliation:
Infection Prevention and Control, Alberta Health Services, Alberta, Canada
Jennifer Ellison
Affiliation:
Infection Prevention and Control, Alberta Health Services, Alberta, Canada
Jenine Leal
Affiliation:
Infection Prevention and Control, Alberta Health Services, Alberta, Canada Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada O’Brien Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
Kathryn R. Bush
Affiliation:
Infection Prevention and Control, Alberta Health Services, Alberta, Canada
A. Uma Chandran
Affiliation:
Infection Prevention and Control, Alberta Health Services, Alberta, Canada Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta, Canada
Sumana Fathima
Affiliation:
Analytics and Performance Reporting Branch, Alberta Ministry of Health, Edmonton, Alberta, Canada
John M. Conly
Affiliation:
Infection Prevention and Control, Alberta Health Services, Alberta, Canada Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada O’Brien Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada Department of Pathology and Laboratory Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada Snyder Institute for Chronic Diseases, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
Corresponding
E-mail address:

Abstract

Objective:

Adverse outcomes following Clostridioides difficile infection (CDI) are not often reported for long-term care facility (LTCF) residents. We focused on the adverse outcomes due to CDI identified in Alberta LTCFs.

Methods:

All positive Clostridioides difficile stool specimens identified by laboratory-identified (LabID) event surveillance in Alberta from 2011 to 2018, along with Alberta Continuing Care Information System, were used to define CDI in Alberta LTCFs. CDI cases were classified as long-term care onset, hospital onset, and community onset. Laboratory records were linked to provincial databases to analyze acute-care admissions and mortality within 30-day post CDI. Age, sex, case classification, episode, and operator type, were investigated using logistic regression.

Results:

Overall, 902 CDI cases were identified in 762 LTCF residents. Of all CDI events, 860 (95.3%) were long-term care onset, 38 (4.2%) were hospital onset, and 4 (0.4%) were community onset. The CDI rate was 2.0 of 100,000 resident days. In total, 157 residents (20.6%) had 30-day all-cause mortality, 126 CDI cases (14.0%) had 30-day all-cause acute-care admissions. The 30-day all-cause mortality rate was significantly higher in residents aged >80 versus ≤80 years (24.9 vs 12.3 per 100 residents; P < .05). Residents aged >80 years, with hospital-onset CDI, and those staying in private or voluntary LTCFs were more likely to have 30-day all-cause acute-care admissions.

Conclusions:

The prevalence of CDI adverse outcomes is in LTCFs was found to be high using LabID event surveillance. Annual review of CDI adverse outcomes using LabID event can minimize the burden of surveillance and standardize the process across all Alberta LTCFs.

Type
Original Article
Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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