Clostridium difficile infection in a long-term care facility: hospital-associated illness compared with long-term care-associated illness.

摘要: BACKGROUND Controversy exists over whether Clostridium difficile infection (CDI) commonly occurs in long-term care facility residents who have not been recently transferred from an acute hospital. OBJECTIVE To assess the incidence and outcome of CDI a facility. METHODS Retrospective cohort study 262-bed Veterans Affairs Pittsburgh, Pennsylvania, for period January 2004 through June 2010. was identified by positive stool C. toxin assay diarrhea. Patients were categorized as hospital-associated (HACDI) or facility-associated (LACDI) followed 6 months. RESULTS The annual rate varied between 0.11 0.23 per 1,000 resident-days HACDI patients 0.04 0.28 LACDI patients. We 162 patients, 96 (59.3%) with 66 (40.7%) LACDI. Median age 74 77 years, respectively, (P = .055) There more at least 1 relapse during months follow up (32/66, 48.5%) than (28/96, 29.2%; P .005). Logistic regression showed that ages 75 years (odds ratio [OR], 2.33; 95% confidence interval [CI], 1.07-5.07; .005), 2 transfers to hospital (OR, 7.88; CI, 1.88-32.95; 3.15; 1.41-7.05; .005) associated CDI. CONCLUSIONS Forty percent cases acquired within facility, indicating substantial degree transmission. Optimal strategies prevent are needed.