126 Acquisition of Clostridium difficile Colonization and Infection in a Department of Veterans Affairs Long-Term Care Facility

Friday, March 19, 2010
Grand Hall (Hyatt Regency Atlanta)
Suresh Ponnada, M.D. , Louis Stokes Cleveland VA Medical Center, Cleveland, OH
Dubert Guerrero, MD , University Hospitals of Cleveland/Case Med. Ctr., Cleveland, OH
Lucy Jury, N.P. , Louis Stokes Cleveland VA Medical Center, Cleveland, OH
Michelle Nerandzic, BS , Louis Stokes Cleveland VA Medical Center, Cleveland, OH
Jen Cadnum , Louis Stokes Cleveland VA Medical Center, Cleveland, OH
Curtis J. Donskey , Cleveland VA Medical Center, Cleveland, OH
Background: In 2006, data from the Ohio Department of Health demonstrated that more than half of all cases of C. difficile infection (CDI) in Ohio had their onset in long-term care facilities. However, it is not known these patients acquired C. difficile in the long-term care facilities or in the hospital prior to transfer to the long-term care facility.
Objective: To test the hypothesis that acquisition C. difficile colonization is common in a Veterans Affairs long-term care facility.                         
Methods: We performed a 5-month prospective study to determine the incidence of acquisition of C. difficile colonization and infection in patients being transferred from the Cleveland Veterans Affairs hospital to an affiliated long-term care facility that includes traditional nursing home residents and post-acute rehabilitation patients. Rectal swabs were cultured for C. difficile at the time of transfer to long-term care and then weekly while in the long-term care facility for up to 6 weeks.                                                       
Results: Of 120 patients transferred to the long-term care facility, 14 (12%) were asymptomatically colonized with C. difficile prior to transfer, and 4 of these 14 patients (29%) developed CDI within 6 weeks. Of the 4 patients who developed CDI, 3 (75%) had recurrent cases and 1 (25%) had an initial CDI episode. Of 85 patients with negative cultures on transfer and at least one follow-up culture, 22 (26%) acquired C. difficile colonization, of whom 15 (68%) acquired colonization within 2 weeks of transfer. Of the 22 patients with new acquisition of C. difficile, 4 (18%) developed CDI, and 3 of 4 (75%) were initial CDI episodes.                                      
Conclusions: In our long-term care facility, acquisition of C. difficile colonization was common and nearly 1 in 5 patients with newly-acquired colonization developed CDI. In long-term care facilities that include post-acute rehabilitation patients, CDI cases are likely to be attributable to both admission of colonized patients from hospitals and transmission of C. difficile within the long-term care facility.