Work

Clostridium difficile in an Urban, University-Affiliated Long-Term Acute Care Hospital

Year: 2016

Type: article

Abstract: Background. Clostridium difficile is the most common cause of healthcare-associated infections in the United States, and has been associated with adverse outcomes in the acute care setting. However, little is known regarding the burden or impact of C. difficile infection (CDI) in long-term acute care hospitals (LTACHs). Methods. A retrospective matched cohort study was performed among patients at an urban, university-affiliated LTACH between July 2008 and October 2015. The incidence rate of LTACH-onset CDI was assessed and patient characteristics associated with adverse outcomes examined. Patients with CDI were matched to concurrently hospitalized LTACH patients without a diagnosis of CDI. A multivariable model using conditional Poisson regression was developed to determine characteristics associated with a composite primary outcome of either 30-day readmission to an acute care hospital or mortality. Results. The overall incidence of CDI was 21.4 cases per 10,000 patient-days, with 27% of infections classified as severe. Patients with CDI had a mean (±SD) age of 70 ±14 years, a mean admission Charlson Comorbidity Index of 4 ± 2, and a median (IQR) length of stay of 33 (24-46) days. Median time between admission and diagnosis of CDI was 16 (9-23) days. No significant difference was found in the rate of the primary outcome between the matched CDI and non-CDI groups (38% vs 36%, respectively; P = 0.82). In the final multivariable analysis, increased creatinine trended towards an increased risk for the primary outcome (RR, 1.30 [95% confidence interval, 0.98-1.73]). Conclusion. LTACH-onset CDI was found to have a relatively high incidence in an urban, university affiliated LTACH. CDI was not a significant risk factor for the composite outcome of 30-day readmission or mortality. Future research should focus on infection prevention and antibiotic stewardship measures to decrease CDI specifically in the LTACH setting. Disclosures. All authors: No reported disclosures

Source: Open Forum Infectious Diseases

DOI: 10.1093/ofid/ofw172.1617

Authors: Jerry Jacob, Jingwei Wu, Jennifer Han, Deborah Nelson

Institutions: University of Pennsylvania, Temple University

Language: English

Topic: Clostridium difficile and Clostridium perfringens research

Subfield: Infectious Diseases

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $4,053