The use of laboratory-identified event surveillance to classify adverse outcomes due to Clostridioides difficile infection in Canadian long-term care facilities

2020 ◽  
pp. 1-8
Author(s):  
Ye Shen ◽  
Jennifer Ellison ◽  
Jenine Leal ◽  
Kathryn R. Bush ◽  
A. Uma Chandran ◽  
...  
Keyword(s):  
Acute Care ◽  
Long Term Care ◽  
Care Facility ◽  
Adverse Outcomes ◽  
Annual Review ◽  
Term Care ◽  
Clostridioides Difficile ◽  
All Cause Mortality ◽  
Community Onset

Abstract Objective: Adverse outcomes following Clostridioides difficile infection (CDI) are not often reported for long-term care facility (LTCF) residents. We focused on the adverse outcomes due to CDI identified in Alberta LTCFs. Methods: All positive Clostridioides difficile stool specimens identified by laboratory-identified (LabID) event surveillance in Alberta from 2011 to 2018, along with Alberta Continuing Care Information System, were used to define CDI in Alberta LTCFs. CDI cases were classified as long-term care onset, hospital onset, and community onset. Laboratory records were linked to provincial databases to analyze acute-care admissions and mortality within 30-day post CDI. Age, sex, case classification, episode, and operator type, were investigated using logistic regression. Results: Overall, 902 CDI cases were identified in 762 LTCF residents. Of all CDI events, 860 (95.3%) were long-term care onset, 38 (4.2%) were hospital onset, and 4 (0.4%) were community onset. The CDI rate was 2.0 of 100,000 resident days. In total, 157 residents (20.6%) had 30-day all-cause mortality, 126 CDI cases (14.0%) had 30-day all-cause acute-care admissions. The 30-day all-cause mortality rate was significantly higher in residents aged >80 versus ≤80 years (24.9 vs 12.3 per 100 residents; P < .05). Residents aged >80 years, with hospital-onset CDI, and those staying in private or voluntary LTCFs were more likely to have 30-day all-cause acute-care admissions. Conclusions: The prevalence of CDI adverse outcomes is in LTCFs was found to be high using LabID event surveillance. Annual review of CDI adverse outcomes using LabID event can minimize the burden of surveillance and standardize the process across all Alberta LTCFs.

scholarly journals Risk factors for COVID-19 diagnosis, hospitalization, and subsequent all-cause mortality in Sweden: a nationwide study

2021 ◽  
Vol 36 (3) ◽  
pp. 287-298
Author(s):  
Jonathan Bergman ◽  
Marcel Ballin ◽  
Anna Nordström ◽  
Peter Nordström
Keyword(s):  
Risk Factors ◽  
Down Syndrome ◽  
Long Term Care ◽  
Care Facility ◽  
Prescription Medication ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
All Cause Mortality

AbstractWe conducted a nationwide, registry-based study to investigate the importance of 34 potential risk factors for coronavirus disease 2019 (COVID-19) diagnosis, hospitalization (with or without intensive care unit [ICU] admission), and subsequent all-cause mortality. The study population comprised all COVID-19 cases confirmed in Sweden by mid-September 2020 (68,575 non-hospitalized, 2494 ICU hospitalized, and 13,589 non-ICU hospitalized) and 434,081 randomly sampled general-population controls. Older age was the strongest risk factor for hospitalization, although the odds of ICU hospitalization decreased after 60–69 years and, after controlling for other risk factors, the odds of non-ICU hospitalization showed no trend after 40–49 years. Residence in a long-term care facility was associated with non-ICU hospitalization. Male sex and the presence of at least one investigated comorbidity or prescription medication were associated with both ICU and non-ICU hospitalization. Three comorbidities associated with both ICU and non-ICU hospitalization were asthma, hypertension, and Down syndrome. History of cancer was not associated with COVID-19 hospitalization, but cancer in the past year was associated with non-ICU hospitalization, after controlling for other risk factors. Cardiovascular disease was weakly associated with non-ICU hospitalization for COVID-19, but not with ICU hospitalization, after adjustment for other risk factors. Excess mortality was observed in both hospitalized and non-hospitalized COVID-19 cases. These results confirm that severe COVID-19 is related to age, sex, and comorbidity in general. The study provides new evidence that hypertension, asthma, Down syndrome, and residence in a long-term care facility are associated with severe COVID-19.

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 780. How Much Does Prior Hospitalization Contribute to Readmission with Community-onset Clostridioides difficile Infection?

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S434-S435
Author(s):  
Alice Guh ◽  
Lauren C Korhonen ◽  
Lisa Gail Winston ◽  
Brittany Martin ◽  
Helen Johnston ◽  
...  
Keyword(s):  
Care Facility ◽  
Healthcare Facility ◽  
Care Hospital ◽  
Emerging Infections ◽  
Post Discharge ◽  
Term Care ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Community Onset

Abstract Background Interventions to reduce community-onset (CO) Clostridioides difficile Infection (CDI) are not usually hospital-based due to the perception that they are often acquired outside the hospital. We determined the proportion of admitted CO CDI that might be associated with previous hospitalization. Methods The CDC’s Emerging Infections Program conducts population-based CDI surveillance in 10 US sites. We defined an incident case as a C. difficile-positive stool collected in 2017 from a person aged ≥ 1 year admitted to a hospital with no positive tests in the prior 8 weeks. Cases were defined as CO if stool was collected within 3 days of hospitalization. CO cases were classified into four categories: long-term care facility (LTCF)-onset if patient was admitted from an LTCF; long-term acute care hospital (LTACH)-onset if patient was admitted from an LTACH; CO-healthcare-facility associated (CO-HCFA) if patient was admitted from a private residence but had a prior healthcare-facility admission in the past 12 weeks; or community-associated (CA) if there was no admission to a healthcare facility in the prior 12 weeks. We excluded hospitals with &lt; 10 cases among admitted catchment-area residents. Results Of 4724 cases in 86 hospitals, 2984 (63.2%) were CO (median per hospital: 65.8%; interquartile range [IQR]: 58.3%-70.7%). Among the CO cases, 1424 (47.7%) were CA (median per hospital: 48.1%; IQR: 40.3%-57.7%), 1201 (40.3%) were CO-HCFA (median per hospital: 41.0%; IQR: 32.9%-47.8%), 350 (11.7%) were LTCF-onset (median per hospital: 10.0%; IQR: 0.6%-14.4%), and 9 (0.3%) were LTACH-onset. Of 1201 CO-HCFA cases, 1174 (97.8%) had a prior hospitalization; among these, 978 (83.3%) (median per hospital: 83.3%; IQR: 69.2%-90.6%), which consists of 32.8% of all hospitalized CO cases, had been discharged from the same hospital (Figure), and 84.4% of the 978 cases (median per hospital: 88.2%: IQR: 76.5%-100.0%) had received antibiotics sometime in the prior 12 weeks. Figure. Frequency of Cases Discharged in the 12 Weeks Prior to Readmission with Clostridioides difficile Infection (N=1138*) Conclusion A third of hospitalized CO CDI had been recently discharged from the same hospital, and most had received antibiotics during or soon after the last admission. Hospital-based and post-discharge antibiotic stewardship interventions could help reduce subsequent CDI hospitalizations. Disclosures Ghinwa Dumyati, MD, Roche Diagnostics (Consultant)

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.

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

scholarly journals Long-Term Care Facilities: Important Participants of the Acute Care Facility Social Network?

PLoS ONE ◽  
2011 ◽  
Vol 6 (12) ◽  
pp. e29342 ◽  
Author(s):  
Bruce Y. Lee ◽  
Yeohan Song ◽  
Sarah M. Bartsch ◽  
Diane S. Kim ◽  
Ashima Singh ◽  
...  
Keyword(s):  
Social Network ◽  
Acute Care ◽  
Long Term Care ◽  
Care Facility ◽  
Term Care ◽  
Acute Care Facility ◽  
Care Facilities

scholarly journals Longitudinal Trends of Clostridium difficile Infection (CDI) within Department of Veterans Affairs (VA) Medical Centers—Acute Care and Long-term Care

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S390-S391
Author(s):  
Stephen Kralovic ◽  
Martin Evans ◽  
Loretta Simbartl ◽  
Gary Roselle
Keyword(s):  
Acute Care ◽  
Long Term Care ◽  
Healthcare Facility ◽  
Healthcare Associated Infection ◽  
Chi Square ◽  
Term Care ◽  
Medical Centers ◽  
Chi Square Analysis ◽  
Community Onset

Abstract Background CDI remains a significant and serious healthcare-associated infection within hospital and long-term care (LTC) settings. In 2012 VA began a CDI Prevention Initiative in its acute care (AC) facilities, which expanded to include LTC. Data were collected with regard to CDI cases and healthcare-facility associated (HCFA) status. Methods VA used CDC National Healthcare Safety Network (NHSN) Lab-ID Event definitions from CDI/MDRO Module with the exception that HCFA-status was called with a more stringent timeframe at 48 hours after admission. Monthly, VA Medical Centers and LTC Facilities report data to a central repository which includes number of cases meeting NHSN definitions for recurrence, hospital onset HCFA (HO-HCFA), community-onset HCFA (CO-HCFA) and community-onset non HCFA (CO-notHCFA) cases (equivalent of NSHN community-acquired [CA] cases). Data collection began from 2011 forward in AC, and from part of 2012 forward in LTC. Results In AC, the number of all cases reported ranged from 6313 to 6595 with no trend for increase/decrease noted from 2011 to 2016. However, when evaluating proportions of each type of CDI contributing to the overall occurrence, there is significant change over the years (P &lt; 0.0001, Chi-Square analysis of proportions) with HO-HCFA and CO-HCFA contributing to less (24.4% and 25.2%, decreases, respectively) and CO cases (particularly CO-notHCFA) contributing to more (38.1% increase) of the cases, (Fig 1). In LTC, there were overall lesser cases ranging from 980 to 789 from 2013 through 2016 (P = 0.05, linear regression), with no significant changes over the years (P = 0.06, Chi-Square of proportions) (Fig 2). Conclusion Over time, HO-HCFA and CO-HCFA cases have declined within VA AC facilities. However, an increase of CO-notHCFA cases (similar to NHSN CA cases) has occurred, increasing admission prevalence of CDI at VA facilities. As CDI prevalence on admission is a contributor to risk for HCFA disease, this increased pressure indicates the success of the VA CDI Prevention Initiative in decreases of HO-HCFA is even more substantive than raw rates would indicate. However, it also highlights a group of CDI cases which need a different, focused targeting of prevention strategies. Disclosures All authors: No reported disclosures.

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