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Acquisition of Clostridium difficile Colonization and Infection After Transfer From a Veterans Affairs Hospital to an Affiliated Long-Term Care Facility

Published online by Cambridge University Press:  11 July 2017

Suresh Ponnada ,
Dubert M. Guerrero ,
Lucy A. Jury ,
Michelle M. Nerandzic ,
Jennifer L. Cadnum ,
M. Jahangir Alam  and
Curtis J. Donskey
Suresh Ponnada
Affiliation:
Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
Dubert M. Guerrero
Affiliation:
Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio University Hospitals Cleveland Medical Center, Cleveland, Ohio
Lucy A. Jury
Affiliation:
Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
Michelle M. Nerandzic
Affiliation:
Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
Jennifer L. Cadnum
Affiliation:
Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
M. Jahangir Alam
Affiliation:
College of Pharmacy, University of Houston, Houston, Texas
Curtis J. Donskey*
Affiliation:
Geriatric Research, Education and Clinical Center, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio Case Western Reserve University School of Medicine, Cleveland, Ohio
*
Address correspondence to Curtis J. Donskey, MD, Geriatric Research, Education and Clinical Center, Louis Stokes Veterans Affairs Medical Center, 10701 East Blvd, Cleveland, OH 44106 (curtisd123@yahoo.com).
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Abstract

BACKGROUND

Clostridium difficile infection (CDI) and asymptomatic carriage of toxigenic C. difficile are common in long-term care facilities (LTCFs). However, whether C. difficile is frequently acquired in the LTCF versus during acute-care admissions remains unknown.

OBJECTIVE

To test the hypothesis that LTCF residents often acquire C. difficile colonization and infection in the LTCF

DESIGN

This 5-month cohort study was conducted to determine the incidence of acquisition of C. difficile colonization and infection in asymptomatic patients transferred from a Veterans Affairs hospital to an affiliated LTCF.

METHODS

Rectal swabs were cultured for toxigenic C. difficile at the time of transfer to the LTCF and weekly for up to 6 weeks. We calculated the proportion of LTCF-onset CDI cases within 1 month of transfer that occurred in residents colonized on admission versus those with new acquisition in the LTCF.

RESULTS

Of 110 patients transferred to the LTCF, 12 (11%) were asymptomatically colonized with toxigenic C. difficile upon admission, and 4 of these 12 patients (33%) developed CDI within 1 month, including 3 recurrent and 1 initial CDI episode. Of 82 patients with negative cultures on transfer and at least 1 follow-up culture, 22 (27%) acquired toxigenic C. difficile colonization, and 4 developed CDI within 1 month, including 1 recurrent and 3 initial CDI episodes.

CONCLUSION

LTCF residents frequently acquired colonization with toxigenic C. difficile after transfer from the hospital, and 3 of 4 initial CDI cases with onset within 1 month of transfer occurred in residents who acquired colonization in the LTCF.

Infect Control Hosp Epidemiol 2017;38:1070–1076

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 9 , September 2017 , pp. 1070 - 1076
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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