C. difficile Burden Inside Long Term Care Facilities

JANUARY 16, 2017
Rachel Lutz

Long-term acute care hospitals recently reported a high incidence rate of Clostridium difficile (C. difficile) infection.

Researchers from the University of Pennsylvania analyzed C. difficile infection between July 2008 and October 2015 inside an urban long-term acute care hospital with 38 beds to determine the impact of such infections. The study authors matched infected patients to concurrently hospitalized uninfected patients – admitted within three days of each other – to determine the incidence rate as well as calculate the 30-day readmission rate to an acute care hospital or mortality.

According to the study authors, even though C. difficile infection has been known to cause adverse outcomes such as increased cost, prolonged length of stay, and substantial infection related morbidity and mortality in acute care settings, there is still little evidence about this impact in long term facilities. Patients are beginning to rely more heavily on these long-term care centers as the population ages, the researchers explained.

There were 21.4 cases of C. difficile infection per 10,000 patient days, the investigators determined. Among those cases, about a quarter of them were classified as severe, or 5.6 cases of severe C. difficile infection per 10,000 patient days. On average, the infected patients were about 70 years old and had a mean length of stay of 33 days. An average of 16 days lapsed between admissions and diagnosis with C. difficile infection. The researchers did not report any significant differences between the rate of the primary outcome between the matched C. difficile infection and the non-infected groups (38% vs. 36%, respectively).

The most common antibiotic administered leading up to the patients’ C. difficile infection was cephalosporin, the researchers reported.

Additionally, the investigators observed that 23 unmatched patients were found to have longer median time between admission and C. difficile infection onset as well as a longer median length of stay.
According to 2010 data, the incidence of C. difficile infection in acute care hospitals was 5.4 per 10,000 patient days, meaning the baseline incidence of long term acute care hospitals was significantly higher, the researchers extrapolated. Additionally, the rate of severe cases was 2.5 times higher in long term facilities compared to acute care hospitals using the same criteria (27% vs. 10.9%, respectively).

The study authors said that there was no significant link between C. difficile infection and composite outcome of 30-day readmission or mortality. They added that future studies are recommended in order to guide more research centered on long term acute care hospital interventions, particularly antimicrobial stewardship programs. This, they said, could decrease the high burden of C. difficile infection in these facilities.

The paper, “Clostridium difficile in an Urban, University-Affiliated Long-Term Acute-Care Hospital” was published in the journal Infection Control & Hospital Epidemiology.
 
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