386 The Impact of Hospital-Onset Healthcare Facility Associated (HO-HCFA) Clostridium Difficile Infection (CDI) in Community Hospitals: Surpassing Methicillin-Resistant Staphylococcus aureus (MRSA) as the New Superbug

Saturday, March 20, 2010: 9:00 AM
Centennial Ballroom (Hyatt Regency Atlanta)
Becky A. Miller, MD , Duke University Medical Center, Durham, NC
Luke F. Chen, MBBS, FRACP , Duke University Medical Center, Durham, NC
Daniel J. Sexton, MD, FACP , Duke University Medical Center, Durham, NC
Deverick J. Anderson, MD, MPH , Duke University Medical Center, Durham, NC

Background:   CDI is more frequent and more severe. The majority of studies describing these epidemiologic changes have taken place in large, tertiary care facilities despite the fact that community hospitals are responsible for the majority of patient care in the US.  The impact of HO-HCFA CDI on community hospitals is not well known.

Objective:   The objectives of this study were to 1) describe the epidemiology of HO-HCFA CDI in community hospitals and 2) measure the impact of HO-HCFA CDI in comparison to other HAIs in community hospitals.

Methods:   We conducted a cohort study of patients at 30 community hospitals in the Duke Infection Control Outreach Network (DICON) from 1/1/2008 to 6/30/2009.  Data pertaining to HO-HCFA CDI, hospital-wide bloodstream infection (BSI), ICU-related BSI, ventilator-associated pneumonia (VAP), catheter-associated urinary tract infection (CAUTI), and infections due to MRSA were prospectively collected from standardized surveillance databases.  Cases of hospital-wide BSI included cases of ICU-BSI.  Cases were defined according to CDC criteria.  


Results:   In total, 612 cases of HO-HCFA CDI (0.26 cases/1000 patient-days), 650 cases of hospital-wide BSI (0.28/1000 pt-days), and 505 cases of infection due to MRSA (0.22/1000 patient-days) occurred during 2,322,293 patient days within the study period. HO-HCFA CDI was 21% more common than MRSA infection (relative rate 1.21; 95 % CI 1.08-1.36, p=0.001) and approximately as common as hospital-wide BSI (relative rate 0.94; 95% CI 0.84-1.05, p=0.28).  In addition, 182 cases of ICU-BSI (0.07/1000 catheter-days), 102 cases of VAP (0.04/1000 ventilator-days), and 197 cases of CAUTI (0.08/1000 catheter-days) were identified.  The relative contribution of each type of HAI was as follows: 42% hospital-wide BSI, 39% HO-HCFA CDI, 32% MRSA, 31% combined ICU-related infections (BSI, VAP, and CAUTI). 

Conclusions:   HO-HCFA CDI was more common than infection due to MRSA and as common as hospital-wide BSI in this cohort of patients from community hospitals within DICON.  Epidemiologic studies are needed to determine whether prescribing practices, geographic differences, improved infection control practices leading to a reduction in infections due to MRSA, or other patient factors are involved.  Development of effective prevention strategies for this emerging infection is needed.