Transmission ofClostridium difficilefrom asymptomatically colonized or infected long-term care facility residents

2018 ◽  
Vol 39 (8) ◽  
pp. 909-916 ◽  
Author(s):  
Curtis J. Donskey ◽  
Venkata C. K. Sunkesula ◽  
Nimalie D. Stone ◽  
Carolyn V. Gould ◽  
L. Clifford McDonald ◽  
...  
Keyword(s):  
Acute Care ◽  
Long Term Care ◽  
Hospital Admissions ◽  
Care Facility ◽  
Term Care ◽  
Term Care Facility ◽  
Asymptomatic Carriers ◽  
Long Term Care Facility ◽  
Asymptomatic Carriage

AbstractObjectiveTo test the hypothesis that long-term care facility (LTCF) residents withClostridium difficileinfection (CDI) or asymptomatic carriage of toxigenic strains are an important source of transmission in the LTCF and in the hospital during acute-care admissions.DesignA 6-month cohort study with identification of transmission events was conducted based on tracking of patient movement combined with restriction endonuclease analysis (REA) and whole-genome sequencing (WGS).SettingVeterans Affairs hospital and affiliated LTCF.ParticipantsThe study included 29 LTCF residents identified as asymptomatic carriers of toxigenicC. difficilebased on every other week perirectal screening and 37 healthcare facility-associated CDI cases (ie, diagnosis >3 days after admission or within 4 weeks of discharge to the community), including 26 hospital-associated and 11 LTCF-associated cases.ResultsOf the 37 CDI cases, 7 (18·9%) were linked to LTCF residents with LTCF-associated CDI or asymptomatic carriage, including 3 of 26 hospital-associated CDI cases (11·5%) and 4 of 11 LTCF-associated cases (36·4%). Of the 7 transmissions linked to LTCF residents, 5 (71·4%) were linked to asymptomatic carriers versus 2 (28·6%) to CDI cases, and all involved transmission of epidemic BI/NAP1/027 strains. No incident hospital-associated CDI cases were linked to other hospital-associated CDI cases.ConclusionsOur findings suggest that LTCF residents with asymptomatic carriage ofC. difficileor CDI contribute to transmission both in the LTCF and in the affiliated hospital during acute-care admissions. Greater emphasis on infection control measures and antimicrobial stewardship in LTCFs is needed, and these efforts should focus on LTCF residents during hospital admissions.

Clostridium difficileInfection in a Long-Term Care Facility: Hospital-Associated Illness Compared with Long-Term Care-Associated Illness

2011 ◽  
Vol 32 (7) ◽  
pp. 656-660 ◽  
Author(s):  
Jong Hun Kim ◽  
Diana Toy ◽  
Robert R. Muder
Keyword(s):  
Acute Care ◽  
Long Term Care ◽  
Acute Care Hospital ◽  
Care Facility ◽  
Optimal Strategies ◽  
Care Hospital ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility

Background.Controversy exists over whetherClostridium difficileinfection (CDI) commonly occurs in long-term care facility residents who have not been recently transferred from an acute care hospital.Objective.To assess the incidence and outcome of CDI in a long-term care facility.Methods.Retrospective cohort study in a 262-bed long-term care Veterans Affairs facility in Pittsburgh, Pennsylvania, for the period January 2004 through June 2010. CDI was identified by positive stoolC. difficiletoxin assay and acute diarrhea. Patients were categorized as hospital-associated CDI (HACDI) or long-term care facility–associated CDI (LACDI) and followed for 6 months.Results.The annual rate of CDI varied between 0.11 and 0.23 per 1,000 resident-days for HACDI patients and between 0.04 and 0.28 per 1,000 resident-days for LACDI patients. We identified 162 patients, 96 patients (59.3%) with HACDI and 66 patients (40.7%) with LACDI. Median age was 74 and 77 years, respectively, for HACDI and LACDI (P= .055) patients. There were more patients with at least 1 relapse of CDI during 6 months of follow up in LACDI patients (32/66, 48.5%) than in HACDI patients (28/96, 29.2%;P= .009). Logistic regression showed that ages of at least 75 years (odds ratio [OR], 2.33; 95% confidence interval [CI], 1.07–5.07;P= .033), more than 2 transfers to an acute care hospital (OR, 7.88; 95% CI, 1.88–32.95;P= .005), and LACDI (OR, 3.15; 95% CI, 1.41–7.05;P= .005) were associated with relapse of CDI.Conclusions.Forty percent of CDI cases were acquired within the long-term care facility, indicating a substantial degree of transmission. Optimal strategies to prevent CDI in the long-term care facility are needed.

scholarly journals 529Frequent Transmission of Clostridium Difficile by Asymptomatically Colonized Long-term Care Facility Residents during Hospital Admissions

2014 ◽  
Vol 1 (suppl_1) ◽  
pp. S17-S18
Author(s):  
Curtis J. Donskey ◽  
Venkata C.K. Sunkesula ◽  
Nimalie D. Stone ◽  
Carolyn V. Gould ◽  
L. Clifford Mcdonald ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Long Term Care ◽  
Hospital Admissions ◽  
Care Facility ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility

Potential for Transmission of Clostridium difficile by Asymptomatic Acute Care Patients and Long-Term Care Facility Residents with Prior C. difficile Infection

2012 ◽  
Vol 33 (6) ◽  
pp. 638-639 ◽  
Author(s):  
Sadao Jinno ◽  
Sirisha Kundrapu ◽  
Dubert M. Guerrero ◽  
Lucy A. Jury ◽  
Michelle M. Nerandzic ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Acute Care ◽  
Long Term Care ◽  
Care Facility ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility

Colonization and Transmission of High-Level Gentamicin-Resistant Enterococci in a Long-Term Care Facility

1994 ◽  
Vol 15 (11) ◽  
pp. 703-709 ◽  
Author(s):  
Carol E. Chenoweth ◽  
Suzanne F. Bradley ◽  
Margaret S. Terpenning ◽  
Lidija T. Zarins ◽  
Mary A. Ramsey ◽  
...  
Keyword(s):  
Acute Care ◽  
Long Term Care ◽  
Acute Care Hospital ◽  
Care Facility ◽  
Care Hospital ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
High Level

AbstractObjectives:To assess the prevalence of high-level gentamicin-resistant enterococcus (HGRE) colonization, transmission patterns, and spectrum of illness among residents of a long-term care facility.Design:Monthly surveillance for HGRE colonization of wounds, rectum, and perineum over a 1-year period.Setting:A Veterans Affairs long-term care facility attached to an acute-care facility.Patients:All 341 patients in the facility during the observation period.Results:Over the 1-year period, 120 patients (35.2%) were colonized with HGRE at least once, with an overall monthly colonization rate of 20± 1.5%. HGRE were isolated from rectum (12.8%), wounds (11.7%), and perineum (9.3%). Patients with the poorest functional status had the highest rate of colonization (P<0.0005). HGRE-colonized patients were more likely to be colonized with methicillin-resistantStaphylococcus aureus(51% versus 25%; P<0.0005). Seventy-four patients (21.7%) were colonized at admission or at the start of the study. Another 46 patients (13.5%) acquired HGRE during the study, including 36 who acquired HGRE while in the long-term care facility and 10 who were positive when transferred back from the acute-care hospital. Based on plasmid profiles, only two patients appeared to have isolates similar to those of current or previous roommates. Carriage of HGRE was transient in most cases. Only 20 patients were colonized for 4 or more months, and those patients usually carried different strains intermittently. Infections were infrequent, occurring in only 4.1% of total patients.Conclusions:In our long-term care facility, HGRE were endemic, and new acquisition of HGRE occurred frequently. However, only two patients had evidence of acquisition from a roommate, suggesting that cross-infection from a roommate was not a major route of spread of HGRE.

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