scholarly journals The Clinical Burden of Clostridioides difficile in Ontario, Canada

2019 ◽  
Vol 7 (2) ◽  
Author(s):  
Jennifer A Pereira ◽  
Allison McGeer ◽  
Antigona Tomovici ◽  
Alex Selmani ◽  
Ayman Chit
Keyword(s):  
Mortality Rates ◽  
Outcome Data ◽  
Term Care ◽  
Individual Level ◽  
Clostridioides Difficile ◽  
Clinical Burden ◽  
Level Data ◽  
Clostridioides Difficile Infection ◽  
Community Onset

Abstract Background To understand the clinical burden of Clostridioides difficile infection (CDI), we analyzed health outcome data from Ontario, Canada for CDI associated with and manifested in acute care hospitals (ACH), long-term care facilities (LTCF), the community, or ACH-associated with community-onset. Methods We performed a retrospective analysis using individual-level data from Ontario databases (April 1, 2005 to March 31, 2015), identifying CDI cases ≥18 years requiring hospitalization, and stratifying into cohorts based on association and onset location. Cohort members were matched to controls on demographics and medical conditions at onset, for outcomes including 30- and 180-day all-cause mortality and rehospitalization. Results We stratified 22 617 individuals hospitalized with CDI during the study period: 13 152 (58.1%) ACH-associated/ACH-onset, 7116 (31.5%) community-associated/community-onset, 1847 (8.2%) ACH-associated/community-onset, and 502 (2.2%) LTCF-associated/LTCF-onset. Compared with controls, unadjusted 30-day rehospitalization rates were significantly higher (P < .0001) for ACH-associated/ACH-onset CDI (9.5% vs 0.4%), LTCF-associated/LTCF-onset (7.2% vs 1.1%), community-associated/community-onset (7.8% vs 0.8%), and ACH-associated/community-onset (10.9% vs 0.7%). One hundred eighty-day mortality rates were higher in the community-associated/community-onset and the LTCF-associated/LTCF-onset cohorts than controls: 66.3% vs 12.3% (P < .0001) and 30.9% vs 3.1% (P < .0001), respectively. All differences remained significant after adjusting for patient factors. Conclusions Clostridioides difficile infection is associated with higher rates of 30-day rehospitalization compared with controls. In addition, mortality rates within 180-days of hospital discharge are significantly higher for community-associated/community-onset and LTCF-associated/LTCF-onset CDI cohorts than controls. Clostridioides difficile infection warrants increased prevention and monitoring efforts.

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 < 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)

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.

Efficacy of a stewardship intervention focused on reducing unnecessary use of non–Clostridioides difficile antibiotics in patients with Clostridioides difficile infection

2019 ◽  
pp. 1-3
Author(s):  
Michelle T. Hecker ◽  
Andrea H. Son ◽  
Heba Alhmidi ◽  
Brigid M. Wilson ◽  
Peter M. Wiest ◽  
...  
Keyword(s):  
Long Term Care ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Facility ◽  
Care Hospital ◽  
Term Care ◽  
Long Term Care Facility ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection

Abstract In a tertiary-care hospital and affiliated long-term care facility, a stewardship intervention focused on patients with Clostridioides difficile infection (CDI) was associated with a significant reduction in unnecessary non-CDI antibiotic therapy. However, there was no significant reduction in total non-CDI therapy or in the frequency of CDI recurrence.

scholarly journals It Is Not Just Mortality: A Call From Chile for Comprehensive COVID-19 Policy Responses Among Older People

2020 ◽  
Author(s):  
Pablo Villalobos Dintrans ◽  
Jorge Browne ◽  
Ignacio Madero-Cabib
Keyword(s):  
Older People ◽  
National Level ◽  
Health Issues ◽  
Negative Consequences ◽  
Access To Health Services ◽  
Term Care ◽  
Policy Responses ◽  
Level Data ◽  
Definition Of

Abstract Objective Provide a synthesis of the COVID-19 policies targeting older people in Chile, stressing their short- and long-term challenges. Method Critical analysis of the current legal and policy measures, based on national-level data and international experiences. Results Although several policies have been enacted to protect older people from COVID-19, these measures could have important unintended negative consequences in this group’s mental and physical health, as well as financial aspects. Discussion A wider perspective is needed to include a broader definition of health—considering financial scarcity, access to health services, mental health issues, and long-term care—in the policy responses to COVID-19 targeted to older people in Chile.

Conclusion: What academia can contribute to refugee policy

2018 ◽  
Vol 56 (1) ◽  
pp. 146-151 ◽  
Author(s):  
Idean Salehyan
Keyword(s):  
Academic Research ◽  
Forced Migration ◽  
Humanitarian Assistance ◽  
Future Research ◽  
Security Risks ◽  
Individual Level ◽  
The Public ◽  
Level Data ◽  
Potential Risks

This conclusion to the special issue highlights the role of scholars in advancing the public discussion about forced migration. As countries around the world are adopting increasing restrictions on the entry of refugees, academic research can help to dispel some of the myths and apprehensions regarding the risks that forced migration entails. While refugees may be linked to conflict and violence in limited circumstances, the research generally demonstrates that robust international cooperation to manage refugee settlements, provide adequate humanitarian assistance, and integrate refugees into host communities, among other policies, can help to mitigate potential risks. Directions for future research and analysis are also discussed. Forced migration scholars should endeavor to collect more individual-level data; seek to understand factors that exacerbate or reduce security risks associated with cross-border militancy; conduct research on the long-term integration of refugees; and seek to understand the causes and consequences of resettlement and repatriation policies.

scholarly journals 2044. An Assessment and Feedback Model Bringing Antimicrobial Stewardship Program Expertise to Long-Term Care Facilities

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S687-S687
Author(s):  
Philip Chung ◽  
Kate Tyner ◽  
Scott Bergman ◽  
Teresa Micheels ◽  
Mark E Rupp ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Long Term Care ◽  
Rank Test ◽  
Post Intervention ◽  
Term Care ◽  
Clostridioides Difficile ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Care Facilities

Abstract Background Long-term care facilities (LTCF) often struggle with implementation of antimicrobial stewardship programs (ASP) that meet all CDC core elements (CE). The CDC recommends partnership with infectious diseases (ID)/ASP experts to guide ASP implementation. The Nebraska Antimicrobial Stewardship Assessment and Promotion Program (ASAP) is an initiative funded by NE DHHS via a CDC grant to assist healthcare facilities with ASP implementation. Methods ASAP performed on-site baseline evaluation of ASP in 5 LTCF (42–293 beds) in the spring of 2017 using a 64-item questionnaire based on CDC CE. After interviewing ASP members, ASAP provided prioritized facility-specific recommendations for ASP implementation. LTCF were periodically contacted in the next 12 months to provide implementation support and evaluate progress. The number of CE met, recommendations implemented, antibiotic starts (AS) and days of therapy (DOT)/1000 resident-days (RD), and incidence of facility-onset Clostridioides difficile infections (FO-CDI) were compared 6 to 12 months before and after on-site visits. Paired t-test and Wilcoxon signed rank test were used for statistical analyses. Results Multidisciplinary ASP existed in all 5 facilities at baseline with medical directors (n = 2) or directors of nursing (n = 3) designated as team leads. Median CE implemented increased from 3 at baseline to 6 at the end of follow-up (P = 0.06). No LTCF had all 7 CE at baseline. By the end of one year, 2 facilities implemented all 7 CE with the remaining implementing 6 CE. LTCF not meeting all CE were only deficient in reporting ASP metrics to providers and staff. Among the 38 recommendations provided by ASAP, 82% were partially or fully implemented. Mean AS/1000 RD reduced by 19% from 10.1 at baseline to 8.2 post-intervention (P = 0.37) and DOT/1000 RD decreased by 21% from 91.7 to 72.5 (P = 0.20). The average incidence of FO-CDI decreased by 75% from 0.53 to 0.13 cases/10,000 RD (P = 0.25). Conclusion Assessment of LTCF ASP along with feedback for improvement by ID/ASP experts resulted in more programs meeting all 7 CE. Favorable reductions in antimicrobial use and CDI rates were also observed. Moving forward, the availability of these services should be expanded to all LTCFs struggling with ASP implementation. Disclosures All authors: No reported disclosures.

Medicaid Expansion

2018 ◽  
Vol 2 (2) ◽  
pp. 42-53
Author(s):  
Mary Schmeida ◽  
Ramona McNeal
Keyword(s):  
Long Term Care ◽  
Financial Incentive ◽  
State Level ◽  
Care Program ◽  
Nursing Facility ◽  
Term Care ◽  
Care Services ◽  
Patient Protection ◽  
Level Data

U.S. longevity is placing a demand on long-term care services for the impaired and elderly. Medicaid is the primary insurance program in funding costly long-term care for the aged poor. As a major health reform law, the 2010 Patient Protection and Affordable Care Act, Public Law 111-148, gives financial incentive for states to expand Medicaid, transitioning long-term care services from costly facilities toward home and community-based care. Not all states choose to expand their Medicaid long-term care program despite the financial incentive, but instead they continue spending on nursing facility care despite the less costly option of community care. This article explores why some states have been reluctant to expand long-term care into the community. Regression analysis and 50 state-level data is used.

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