Kevin Antoine Brown1,2, Nick Daneman3, Makoto Jones4, Kevin Nechodom4, Vanessa Stevens4, Frederick R Adler5, Matthew Bidwell Goetz6, Jeanmarie Mayer4, Matthew Samore4. 1. Public Health Ontario, Ontario, Canada. 2. Dalla Lana School of Public Health, Ontario, Canada 3. Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada. 4. Salt Lake Veterans Affairs Medical Center, Salt Lake City, UT. 5. Department of Mathematics and Department of Biology, University of Utah, Salt Lake City. 6. Veterans Affairs Greater Los Angeles Healthcare System and David Geffen School of Medicine at the University of California, Los Angeles.
Abstract
Background: Drivers of differences in Clostridium difficile incidence across acute and long-term care facilities are poorly understood. We sought to obtain a comprehensive picture of C. difficile incidence and risk factors in acute and long-term care. Methods: We conducted a case-cohort study of persons spending at least 3 days in one of 131 acute care or 120 long-term care facilities managed by the United States Veterans Health Administration between 2006 and 2012. Patient (n = 8) and facility factors (n = 5) were included in analyses. The outcome was the incidence of facility-onset laboratory-identified C. difficile infection (CDI), defined as a person with a positive C. difficile test without a positive test in the prior 8 weeks. Results: CDI incidence in acute care was 5 times that observed in long-term care (median, 15.6 vs 3.2 per 10000 person-days). History of antibiotic use was greater in acute care compared to long-term care (median, 739 vs 513 per 1000 person-days) and explained 72% of the variation in C. difficile rates. Importation of C. difficile cases (acute care: patients with recent long-term care attributable infection; long-term care: residents with recent acute care attributable infection) was 3 times higher in long-term care as compared to acute care (median, 52.3 vs 16.2 per 10000 person-days). Conclusions: Facility-level antibiotic use was the main factor driving differences in CDI incidence between acute and long-term care. Importation of acute care C. difficile cases was a greater concern for long-term care as compared to importation of long-term care cases for acute care.
Background: Drivers of differences in Clostridium difficile incidence across acute and long-term care facilities are poorly understood. We sought to obtain a comprehensive picture of C. difficile incidence and risk factors in acute and long-term care. Methods: We conducted a case-cohort study of persons spending at least 3 days in one of 131 acute care or 120 long-term care facilities managed by the United States Veterans Health Administration between 2006 and 2012. Patient (n = 8) and facility factors (n = 5) were included in analyses. The outcome was the incidence of facility-onset laboratory-identified C. difficileinfection (CDI), defined as a person with a positive C. difficile test without a positive test in the prior 8 weeks. Results: CDI incidence in acute care was 5 times that observed in long-term care (median, 15.6 vs 3.2 per 10000 person-days). History of antibiotic use was greater in acute care compared to long-term care (median, 739 vs 513 per 1000 person-days) and explained 72% of the variation in C. difficile rates. Importation of C. difficile cases (acute care: patients with recent long-term care attributable infection; long-term care: residents with recent acute care attributable infection) was 3 times higher in long-term care as compared to acute care (median, 52.3 vs 16.2 per 10000 person-days). Conclusions: Facility-level antibiotic use was the main factor driving differences in CDI incidence between acute and long-term care. Importation of acute care C. difficile cases was a greater concern for long-term care as compared to importation of long-term care cases for acute care.
Authors: David A Nace; Joseph T Hanlon; Christopher J Crnich; Paul J Drinka; Steven J Schweon; Gulsum Anderson; Subashan Perera Journal: JAMA Intern Med Date: 2020-07-01 Impact factor: 21.873
Authors: Ying P Tabak; Arjun Srinivasan; Kalvin C Yu; Stephen G Kurtz; Vikas Gupta; Steven Gelone; Patrick J Scoble; L Clifford McDonald Journal: Infect Control Hosp Epidemiol Date: 2019-09-16 Impact factor: 6.520
Authors: Alexandre R Marra; Eli N Perencevich; Richard E Nelson; Matthew Samore; Karim Khader; Hsiu-Yin Chiang; Margaret L Chorazy; Loreen A Herwaldt; Daniel J Diekema; Michelle F Kuxhausen; Amy Blevins; Melissa A Ward; Jennifer S McDanel; Rajeshwari Nair; Erin Balkenende; Marin L Schweizer Journal: JAMA Netw Open Date: 2020-01-03