Assessment of Clostridium difficile–Associated Disease Surveillance Definitions, North Carolina, 2005

Objective.To determine the timing of community-onset Clostridium difficile–associated disease (CDAD) relative to the patient's last healthcare facility discharge, the association of postdischarge cases with healthcare facility–onset cases, and the influence of postdischarge cases on overall rates and interhospital comparison of rates of CDAD.Design.Retrospective cohort study for the period January 1, 2005, through December 31, 2005.Setting.Catchment areas of 6 acute care hospitals in North Carolina.Methods.We reviewed medical and laboratory records to determine the date of symptom onset, the dates of hospitalization, and stool C. difficile toxin assay results for patients with CDAD who had diarrhea and positive toxin–assay results. Cases were classified as healthcare facility–onset if they were diagnosed more than 48 hours after admission. Cases were defined as community-onset if they were diagnosed in the community or within 48 hours after admission, and were also classified on the basis of the time since the last discharge: if within 4 weeks, community-onset, healthcare facility–associated (CO-HCFA); if 4-12 weeks, indeterminate exposure; and if more than 12 weeks, community-associated. Pearson's correlation coefficient was used to assess the association between monthly rates of healthcare facility–onset, healthcare facility–associated (HO-HCFA) cases and CO-HCFA cases. We performed interhospital rate comparisons using HO-HCFA cases only and using both HO-HCFA and CO-HCFA cases.Results.Of 1046 CDAD cases, 442 (42%) were HO-HCFA cases and 604 (58%) were community-onset cases. Of the 604 community-onset cases, 94 (15%) were CO-HCFA, 40 (7%) were of indeterminate exposure, and 208 (34%) community-associated. A modest correlation was found between monthly rates of HO-HCFA cases and CO-HCFA cases across the 6 hospitals (r = 0.63, P<.001). Interhospital rankings changed for 6 of 11 months if CO-HCFA cases were included.Conclusions.A substantial proportion of community-onset cases of CDAD occur less than 4 weeks after discharge from a healthcare facility, and inclusion of CO-HCFA cases influences interhospital comparisons. Our findings support the use of a proposed definition of healthcare facility–associated CDAD that includes cases that occur within 4 weeks after discharge.

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Multicenter Study of Clostridium difficile Infection Rates from 2000 to 2006

Infection Control and Hospital Epidemiology ◽

10.1086/656245 ◽

2010 ◽

Vol 31 (10) ◽

pp. 1030-1037 ◽

Cited By ~ 77

Author(s):

Erik R. Dubberke ◽

Anne M. Butler ◽

Deborah S. Yokoe ◽

Jeanmarie Mayer ◽

Bala Hota ◽

...

Keyword(s):

Clostridium Difficile ◽

Hospital Admission ◽

Healthcare Facility ◽

The United States ◽

Incidence Rates ◽

Regional Problem ◽

Toxin Assay ◽

Definition Of ◽

Study Hospital ◽

Community Onset

Objective.To compare incidence rates of Clostridium difficile infection (CDI) during a 6-year period among 5 geographically diverse academic medical centers across the United States by use of recommended standardized surveillance definitions of CDI that incorporate recent information on healthcare facility (HCF) exposure.Methods.Data on C. difficile toxin assay results and dates of hospital admission and discharge were collected from electronic databases. Chart review was performed for patients with a positive C. difficile toxin assay result who were identified within 48 hours after hospital admission to determine whether they had any HCF exposure during the 90 days prior to their hospital admission. CDI cases, defined as any inpatient with a stool toxin assay positive for C. difficile, were categorized into 5 surveillance definitions based on recent HCF exposure. Annual CDI rates were calculated and evaluated by use of the χ2 test for trend and the χ2 summary test.Results.During the study period, there were significant increases in the overall incidence rates of HCF-onset, HCF-associated CDI (from 7.0 to 8.5 cases per 10,000 patient-days; P < .001); community-onset, HCF-associated CDI attributed to a study hospital (from 1.1 to 1.3 cases per 10,000 patient-days; P = .003); and community-onset, HCF-associated CDI not attributed to a study hospital (from 0.8 to 1.5 cases per 1,000 admissions overall; P < .001). For each surveillance definition of CDI, there were significant differences in the total incidence rate between HCFs.Conclusions.The increasing incidence rates of CDI over time and across healthcare institutions and the correlation of CDI incidence in different surveillance categories suggest that CDI may be a regional problem and not isolated to a single HCF within a community.

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An Assessment of 2016 National Healthcare Safety Network (NHSN) and National Electronic Disease Surveillance System (NEDSS) Clostridium difficile Infections (CDI) in Nebraska

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.995 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S399-S399

Author(s):

Caitlin Pedati ◽

Madison Sullivan ◽

Margaret Drake ◽

Alison Keyser ◽

Tom Safranek ◽

...

Keyword(s):

Clostridium Difficile ◽

Surveillance System ◽

Disease Surveillance ◽

Healthcare Facility ◽

Data Sources ◽

National Healthcare ◽

Disease Surveillance System ◽

Department Of Health ◽

National Healthcare Safety Network ◽

Community Onset

Abstract Background In 2016 all acute care hospitals, inpatient rehab facilities, and PPS-exempt cancer facilities in Nebraska were required to report laboratory identified (LabID) Clostridium difficile infections (CDIs) to the National Healthcare Safety Network (NHSN). Test results indicating CDIs must be reported to the Nebraska Department of Health and Human Services (NDHHS) via the National Electronic Disease Surveillance System (NEDSS). NHSN and NEDSS represent unique sources of CDI reports in Nebraska. Methods The NHSN Nebraska database was queried for CDIs reported in 2016. All lab tests indicating a CDI in 2016 were extracted from NEDSS. These extracts were analyzed to assess descriptive epidemiologic variables and compared for differences. Results In 2016 there were 1,546 CDI LabID events reported to NHSN Nebraska from 28 facilities. There were 249 outpatient CDIs and 1,297 inpatient CDIs. Infections were further characterized as community-onset (N = 773), community-onset, healthcare facility associated (N = 206), and hospital onset (N = 567). An average of 128 CDIs were reported per month (range: 111–155). In 2016 there were 2,177 lab results indicating a CDI reported to NEDSS among Nebraska residents from 42 facilities. Patient ages ranged from 4 months to 104 years (mean = 58 years). An average of 181 CDIs were reported per month (range: 151–218). Comparison of the two data sources found 781 reports among 591 unique patients at 11 facilities that were made to NHSN and were not in NEDSS. Additionally, there were 1,092 reports from 931 unique patients at 12 facilities that were made to NEDSS and should have been made to NHSN but were not. There were 9 shared facilities that accounted for the majority of these discrepancies. Conclusion NHSN and NEDSS represent two unique data sources that allow for a more comprehensive assessment of CDIs. The number and type of facility that report to each system is slightly different but there is some overlap. Therefore, this comparison allows for detection of a greater number of reports overall and also provides an opportunity for data validation. This assessment identified discrepancies in reporting among 9 facilities that can be targeted for further collaborative efforts to improve CDI reporting and management in Nebraska. Disclosures All authors: No reported disclosures.

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Recommendations for Surveillance of Clostridium difficile–Associated Disease

Infection Control and Hospital Epidemiology ◽

10.1086/511798 ◽

2007 ◽

Vol 28 (2) ◽

pp. 140-145 ◽

Cited By ~ 435

Author(s):

L. Clifford McDonald ◽

Bruno Coignard ◽

Erik Dubberke ◽

Xiaoyan Song ◽

Teresa Horan ◽

...

Keyword(s):

Intensive Care Unit ◽

Clostridium Difficile ◽

Pseudomembranous Colitis ◽

Ad Hoc ◽

Toxic Megacolon ◽

Healthcare Facility ◽

Case Patient ◽

Healthcare Settings ◽

Community Onset ◽

Laboratory Assay

Background.The epidemiology of Clostridium difficile-associated disease (CDAD) is changing, with evidence of increased incidence and severity. However, the understanding of the magnitude of and reasons for this change is currently hampered by the lack of standardized surveillance methods.Objective and Methods.An ad hoc C. difficile surveillance working group was formed to develop interim surveillance definitions and recommendations based on existing literature and expert opinion that can help to improve CDAD surveillance and prevention efforts.Definitions and Recommendations.A CDAD case patient was defined as a patient with symptoms of diarrhea or toxic megacolon combined with a positive result of a laboratory assay and/or endoscopic or histopathologic evidence of pseudomembranous colitis. Recurrent CDAD was defined as repeated episodes within 8 weeks of each other. Severe CDAD was defined by CDAD-associated admission to an intensive care unit, colectomy, or death within 30 days after onset. Case patients were categorized by the setting in which C. difficile was likely acquired, to account for recent evidence that suggests that healthcare facility-associated CDAD may have its onset in the community up to 4 weeks after discharge. Tracking of healthcare facility–onset, healthcare facility–associated CDAD is the minimum surveillance required for healthcare settings; tracking of community–onset, healthcare facility–associated CDAD should be performed only in conjunction with tracking of healthcare facility–onset, healthcare facility–associated CDAD. Community–associated CDAD was defined by symptom onset more than 12 weeks after the last discharge from a healthcare facility. Rates of both healthcare facility–onset, healthcare facility–associated CDAD and community–onset, healthcare facility–associated CDAD should be expressed as case patients per 10,000 patient–days; rates of community-associated CDAD should be expressed as case patients per 100,000 person-years.

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Automated Surveillance of Clostridium difficile Infections Using BioSense

Infection Control and Hospital Epidemiology ◽

10.1086/657633 ◽

2011 ◽

Vol 32 (1) ◽

pp. 26-33 ◽

Cited By ~ 17

Author(s):

Stephen R. Benoit ◽

L. Clifford McDonald ◽

Roseanne English ◽

Jerome I. Tokars

Keyword(s):

Clostridium Difficile ◽

Surveillance System ◽

Laboratory Data ◽

Public Health Importance ◽

Multicenter Cohort Study ◽

Administrative Records ◽

Disease Rates ◽

Automated Surveillance ◽

Toxin Assay ◽

Community Onset

Objective.To determine the feasibility of using electronic laboratory and admission-discharge-transfer data from BioSense, a national automated surveillance system, to apply new modified Clostridium difficile infection (CDI) surveillance definitions and calculate overall and facility-specific rates of disease.Design.Retrospective, multicenter cohort study.Setting.Thirty-four hospitals sending inpatient, emergency department, and /or outpatient data to BioSense.Methods.Laboratory codes and text-parsing methods were used to extract C. difficile-positive toxin assay results from laboratory data sent to BioSense during the period from January 1, 2007, through June 30, 2008; these were merged with administrative records to determine whether cases were community associated or healthcare onset, as well as patient-day data for rate calculations. A patient was classified as having hospital-onset CDI if he or she had a C. difficile toxin-positive result on a stool sample collected 3 or more days after admission and community-onset CDI if the specimen was collected less than 3 days after admission or the patient was not hospitalized.Results.A total of 4,585 patients from 34 hospitals in 12 states had C. difficile-positive assay results. More than half (53.0%) of the cases were community-onset, and 30.8% of these occurred in patients who were recently hospitalized. The overall rate of healthcare-onset CDI was 7.8 cases per 10,000 patient-days, with a range among facilities of 1.5-27.8 cases per 10,000 patient-days.Conclusions.Electronic laboratory data sent to the BioSense surveillance system were successfully used to produce disease rates of CDI comparable to those of other studies, which shows the feasibility of using electronic laboratory data to track a disease of public health importance.

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Population-Based Surveillance of Clostridium difficile Infection in Manitoba, Canada, by Using Interim Surveillance Definitions

Infection Control and Hospital Epidemiology ◽

10.1086/605719 ◽

2009 ◽

Vol 30 (10) ◽

pp. 945-951 ◽

Cited By ~ 52

Author(s):

Pascal J. Lambert ◽

Myrna Dyck ◽

Laura H. Thompson ◽

Greg W. Hammond

Keyword(s):

Nursing Home ◽

Clostridium Difficile ◽

Hospital Admission ◽

Working Group ◽

Surveillance System ◽

Ad Hoc ◽

Healthcare Facility ◽

Population Based ◽

Incident Cases ◽

Community Onset

Objective.TO apply interim surveillance definitions of Clostridium difficile infection (CDI) cases to 1 year of data from the provincewide surveillance system of Manitoba, Canada, to determine the epidemiology of CDI incident cases in a population.Methods.CDI cases were categorized with interim surveillance definitions developed by an ad hoc C. difficile surveillance working group. Incident cases recorded in the provincial CDI database between July 2005 and June 2006 were linked to the provincial hospitalization and nursing home databases and analyzed.Results.One thousand six incident cases were identified over 1 year. Five hundred fifteen (51%) cases were associated with and began in a healthcare facility (HCF), whereas 275 (27%) were associated with and began in the community. An additional 131 (13%) cases were HCF associated but began in the community, while 85 (8%) were of indeterminate origin. Cases of HCF-associated CDI occurred in patients who were older than did cases of community-associated CDI (P < .0001). The provincial rate of community-onset cases was 23.4 per 100,000 person-years, and rates varied among geographic areas. HCF-associated CDI rates among the 10 largest hospitals varied from 0.5 to 8.4 per 10,000 patient-days. The time to CDI onset after hospital admission indicated that 25% of nosocomial cases began by the 8th day, and 50% began by the 17th day.Conclusions.Although the majority of CDI cases were associated with exposure to a HCF, 40% of incident CDI began in the community. Populations with HCF- and community-associated CDI demonstrated significantly different age distributions. The wide variation of rates among HCFs requires explanation. The high percentage of incident cases in the community warrants increased study.

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Clostridium difficile Infections in Veterans Health Administration Acute Care Facilities

Infection Control and Hospital Epidemiology ◽

10.1086/677151 ◽

2014 ◽

Vol 35 (8) ◽

pp. 1037-1042 ◽

Cited By ~ 25

Author(s):

Martin E. Evans ◽

Loretta A. Simbartl ◽

Stephen M. Kralovic ◽

Rajiv Jain ◽

Gary A. Roselle

Keyword(s):

Clostridium Difficile ◽

Acute Care ◽

Hospital Admissions ◽

Healthcare Facility ◽

Resistant Organism ◽

Veterans Health ◽

Health Administration ◽

Case Rate ◽

Community Onset ◽

Admission Prevalence

ObjectiveAn initiative was implemented in July 2012 to decrease Clostridium difficile infections (CDIs) in Veterans Affairs (VA) acute care medical centers nationwide. This is a report of national baseline CDI data collected from the 21 months before implementation of the initiative.MethodsPersonnel at each of 132 data-reporting sites entered monthly retrospective CDI case data from October 2010 through June 2012 into a central database using case definitions similar to those of the National Healthcare Safety Network multidrug-resistant organism/CDI module.ResultsThere were 958,387 hospital admissions, 5,286,841 patient-days, and 9,642 CDI cases reported during the 21-month analysis period. The pooled CDI admission prevalence rate (including recurrent cases) was 0.66 cases per 100 admissions. The nonduplicate/nonrecurrent community-onset not-healthcare-facility-associated (CO-notHCFA) case rate was 0.35 cases per 100 admissions, and the community-onset healthcare facility–associated (CO-HCFA) case rate was 0.14 cases per 100 admissions. Hospital-onset healthcare facility–associated (HO-HCFA), clinically confirmed HO-HCFA (CC-HO-HCFA), and CO-HCFA rates were 9.32, 8.40, and 2.56 cases per 10,000 patient-days, respectively. There were significant decreases in admission prevalence (P = .0006, Poisson regression), HO-HCFA (P = .003), and CC-HO-HCFA (P = .004) rates after adjusting for type of diagnostic test. CO-HCFA and CO-notHCFA rates per 100 admissions also trended downward (P = .07 and .10, respectively).ConclusionsVA acute care medical facility CDI rates were higher than those reported in other healthcare systems, but unlike rates in other venues, they were decreasing or trending downward. Despite these downward trends, there is still a substantial burden of CDI in the system supporting the need for efforts to decrease rates further.

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Hospital-Associated Clostridium difficile Infection: Is It Necessary to Track Community-Onset Disease?

Infection Control and Hospital Epidemiology ◽

10.1086/596604 ◽

2009 ◽

Vol 30 (4) ◽

pp. 332-337 ◽

Cited By ~ 15

Author(s):

Erik R. Dubberke ◽

Kathleen M. McMullen ◽

Jennie L. Mayfield ◽

Kimberly A. Reske ◽

Peter Georgantopoulos ◽

...

Keyword(s):

Clostridium Difficile ◽

Hospital Admission ◽

Care Facility ◽

Healthcare Facility ◽

Generation Cephalosporin ◽

Demographic Characteristics ◽

Fourth Generation ◽

Patient Demographic ◽

Traditional Definition ◽

Community Onset

Objectives.To compare Clostridium difficile infection (CDI) rates determined with use of a traditional definition (ie, with healthcare-onset CDI defined as diagnosis of CDI more than 48 hours after hospital admission) with rates determined with use of expanded definitions, including both healthcare-onset CDI and community-onset CDI, diagnosed within 48 hours after hospital admission in patients who were hospitalized in the previous 30 or 60 days, and to determine whether differences exist between patients with CDI onset in the community and those with CDI onset in a healthcare setting.Design.Prospective cohortSetting.Tertiary acute care facility.Patients.General medicine patients who received a diagnosis of CDI during the period January 1, 2004, through December 31, 2005.Methods.CDI was classified as healthcare-onset CDI, healthcare facility–associated CDI after hospitalization within the previous 30 days, and/or healthcare facility-associated CDI after hospitalization within the previous 60 days. Patient demographic characteristics and medication exposures were obtained. The CDI incidence with use of each definition, CDI rate variability, patient demographic characteristics, and medication exposures were compared.Results.The healthcare-onset CDI rate (1.6 cases per 1,000 patient-days) was significantly lower than the 30-day healthcare facility–associated CDI rate (2.4 cases per 1,000 patient-days; P<.01) and the 60-day healthcare facility–associated CDI rate (2.6 cases per 1,000 patient-days; P<.01). There was good correlation between the healthcare-onset CDI rate and both the 30-day (correlation, 0.69; P<.01) and 60-day (correlation, 0.70; P<.01) healthcare facility–associated CDI rates. There were no months in which the CDI rate was more than 3 standard deviations from the mean. Compared with patients with healthcare-onset CDI, patients with community-onset CDI were less likely to have received a fourth-generation cephalosporin (P = .02) or intravenous vancomycin (P = .01) during hospitalization.Conclusions.Compared with the traditional definition, expanded definitions identify more patients with CDI. There is good correlation between traditional and expanded CDI definitions; therefore, it is unclear whether expanded surveillance is necessary to identify an abnormal change in CDI rates. Cases that met the expanded definitions were less likely to have occurred in patients with fourth-generation cephalosporin and vancomycin exposure.

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Multicenter Study of the Impact of Community-Onset Clostridium difficile Infection on Surveillance for C. difficile Infection

Infection Control and Hospital Epidemiology ◽

10.1086/597380 ◽

2009 ◽

Vol 30 (6) ◽

pp. 518-525 ◽

Cited By ~ 22

Author(s):

Erik R. Dubberke ◽

Anne M. Butler ◽

Bala Hota ◽

Yosef M. Khan ◽

Julie E. Mangino ◽

...

Keyword(s):

Clostridium Difficile ◽

Control Charts ◽

Healthcare Facility ◽

The United States ◽

Outbreak Detection ◽

Multicenter Cohort Study ◽

Time Points ◽

Stool Samples ◽

The Impact ◽

Community Onset

Objective.To evaluate the impact of cases of community-onset, healthcare facility (HCF)-associated Clostridium difficile infection (CDI) on the incidence and outbreak detection of CDI.Design.A retrospective multicenter cohort study.Setting.Five university-affiliated, acute care HCFs in the United States.Methods.We collected data (including results of C. difficile toxin assays of stool samples) on all of the adult patients admitted to the 5 hospitals during the period from July I, 2000, through June 30, 2006. CDI cases were classified as HCF-onset if they were diagnosed more than 48 hours after admission or as community-onset, HCF-associated if they were diagnosed within 48 hours after admission and if the patient had recently been discharged from the HCF. Four surveillance definitions were compared: cases of HCF-onset CDI only (hereafter referred to as HCF-onset CDI) and cases of HCF-onset and community-onset, HCF-associated CDI diagnosed within 30, 60, and 90 days after the last discharge from the study hospital (hereafter referred to as 30-day, 60-day, and 90-day CDI, respectively). Monthly CDI rates were compared. Control charts were used to identify potential CDI outbreaks.Results.The rate of 30-day CDI was significantly higher than the rate of HCF-onset CDI at 2 HCFs (P < .01 ). The rates of 30-day CDI were not statistically significantly different from the rates of 60-day or 90-day CDI at any HCF. The correlations between each HCF's monthly rates of HCF-onset CDI and 30-day CDI were almost perfect (ρ range, 0.94-0.99; P < .001). Overall, 12 time points had a CDI rate that was more than 3 standard deviations above the mean, including 11 time points identified using the definition for HCF-onset CDI and 9 time points identified using the definition for 30-day CDI, with discordant results at 4 time points (k = 0.794; P < .001).Conclusions.Tracking cases of both community-onset and HCF-onset, HCF-associated CDI captures significantly more CDI cases, but surveillance of HCF-onset, HCF-associated CDI alone is sufficient to detect an outbreak.

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A Multicenter Study of Clostridium difficile Infection—Related Colectomy, 2000—2006

Infection Control and Hospital Epidemiology ◽

10.1086/665318 ◽

2012 ◽

Vol 33 (5) ◽

pp. 470-476 ◽

Cited By ~ 29

Author(s):

Amelia M. Kasper ◽

Humaa A. Nyazee ◽

Deborah S. Yokoe ◽

Jeanmarie Mayer ◽

Julie E. Mangino ◽

...

Keyword(s):

Clostridium Difficile ◽

Tertiary Care ◽

Healthcare Facility ◽

The United States ◽

Healthcare Facilities ◽

Tertiary Care Centers ◽

Design And Methods ◽

Study Hospital ◽

Community Onset ◽

Over Time

Objective.To assess Clostridium difficile infection (CDI)-related colectomy rates by CDI surveillance definitions and over time at multiple healthcare facilities.Setting.Five university-affiliated acute care hospitals in the United States.Design and Methods.Cases of CDI and patients who underwent colectomy from July 2000 through June 2006 were identified from 5 US tertiary care centers. Monthly CDI-related colectomy rates were calculated as the number of CDI-related colectomies per 1,000 CDI cases, and cases were categorized according to recommended surveillance definitions. Logistic regression was performed to evaluate risk factors for CDI-related colectomy.Results.In total, 8,569 cases of CDI were identified, and 75 patients underwent CDI-related colectomy. The overall colectomy rate was 8.7 per 1,000 CDI cases. The CDI-related colectomy rate ranged from 0 to 23 per 1,000 CDI episodes across hospitals. The colectomy rate for healthcare-facility-onset CDI was 4.3 per 1,000 CDI cases, and that for community-onset CDI was 16.5 per 1,000 CDI cases (P < .05). There were significantly more CDI-related colectomies at hospitals B and C (P < .05).Conclusions.The overall CDI-related colectomy rate was low, and there was no significant change in the CDI-related colectomy rate over time. Onset of disease outside the study hospital was an independent risk factor for colectomy.

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Genotypic Correlation between Cases of Clostridium difficile (CDI) with Community-Onset Diagnosis after Recent Hospital Discharge and Their Prior Unit-Based Contacts

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.998 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S400-S400

Author(s):

Anoshé Aslam ◽

Jennifer Brite ◽

Tracy McMillen ◽

Hoi Yan Chow ◽

N Esther Babady ◽

...

Keyword(s):

Clostridium Difficile ◽

Infection Control ◽

Hospital Discharge ◽

Incubation Period ◽

Healthcare Facility ◽

Bacterial Spores ◽

Genotypic Correlation ◽

Initial Acquisition ◽

Strain Type ◽

Community Onset

Abstract Background The incubation period of C. difficile infection (CDI) is highly variable. Infections may be diagnosed weeks after initial acquisition of bacterial spores. Such cases of CDI have onset in the community after a recent hospitalization, or upon readmission, and are characterized as community-onset healthcare-facility associated (CO-HCFA) by current surveillance methods. Aim: With the application of multi-locus sequence typing (MLST), our study seeks to characterize genetic concordance between CO-HCFA cases and prior unit-based contacts (donors) sharing the same strain type (ST). Methods For all laboratory-identified cases of CDI from January 1, 2015, through December 31, 2016, patients with CDI onset within 8 weeks of hospital discharge were included in the study. Infection control database was queried to identify putative donors using the following criteria: previous unit occupants with CDI who had been discharged from the same unit less than 4 weeks, 4–8 weeks, and 8–12 weeks before admission of CO-HCFA cases. Intensity of exposure was further characterized by same room or same unit occupancy. Analysis was restricted to endemic strains at our institution (ST 1, 2, 3, 8, 11 and 42). Results During the two year period, 1330 cases were diagnosed with a new CDI episode, 425 community-onset (32%), 440 hospital-onset (33%) and 465 CO-HCFA (35%) cases. Among the 314 unique CO-HCFA patients due to endemic strains, there were a total of 92 same unit contacts with a concordant strain type, and 1035 same unit contacts with a discordant strain type. The proportion of concordant same unit occupants did not differ by time between cases (P = 0.8120). Conclusion CO-HCFA cases account for a third of all new cases of CDI. Genotypic concordance as potential donors was observed among 8% of all indirect unit based CDI contacts of CO-HCFA cases. This association did not vary significantly as the interval between potential exposure and CDI onset in CO-HCFA cases increased. Disclosures All authors: No reported disclosures.

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