• J Am Geriatr Soc · Aug 2017

    Observational Study

    The Attributable Burden of Clostridium difficile Infection to Long-Term Care Facilities Stay: A Clinical Study.

    • Styliani Karanika, Christos Grigoras, Myrto E Flokas, Michail Alevizakos, Tori Kinamon, Erna M Kojic, and Eleftherios Mylonakis.
    • Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island.
    • J Am Geriatr Soc. 2017 Aug 1; 65 (8): 1733-1740.

    BackgroundAdvanced age, history of hospitalization, and antibiotic consumption are associated with the pathogenesis of Clostridium difficile infection (CDI). Long-term care facilities (LTCFs) represent a setting where CDI has been increasingly reported. We aimed to estimate the actual attributable burden of CDI to LTCF stay and determine the characteristics of the disease epidemiology in this setting.DesignIRB-approved retrospective cohort study.SettingLTCF and community.ParticipantsOne thousand seven hundred and sixty-one patients.Measurements/ResultsThe prevalence of CDI among LTCF residents was 22.4%, whereas the prevalence of CDI among community residents was 6.7% (P < .001). The prevalence of CDI among LTCF residents was significantly higher in both the 18-64 (P < .001) and the ≥65 age groups (P < .010). Measures of hospital exposure and antibiotic consumption between LTCF and community residents prior to CDI diagnosis were non-significant. A strict matching (1:2) between LTCF and community residents adjusting for age, total number of hospital admissions and antibiotic consumption showed that the odds of CDI for an LTCF resident were 6.89 times larger than the odds for a community resident (OR = 6.89, 95%, 4.67-10.17). For an LTCF resident with CDI, the odds of manifesting severe disease were 3.25 times larger than the odds for a community resident with CDI (OR = 3.25, 95%, 1.81-5.86). LTCF residents were more frequently hospitalized (P = .002) required longer hospital stays for their CDI management (P = .03) and had more recurrent CDI cases than community residents (P = .04).ConclusionsOur study highlights the increased burden of CDI among LTCF residents independently of age, antibiotic, and hospitalization background. Severe CDI disease and recurrences are more frequent in LTCFs.© 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

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