In the Journals

Patients frequently acquire C. difficile after transfer to long-term care

Patients who were transferred from a Veterans Affairs hospital to a long-term care facility were frequently colonized with Clostridium difficile after their transfer, according to findings recently published in Infection Control and Hospital Epidemiology.

Recent increases in the incidence of Clostridium difficile infection, or CDI, have been observed in all age groups, but the elderly have been disproportionately affected, and long-term care facilities (LTCFs) have borne a significant proportion of the increasing burden of CDI,” Curtis Donskey, MD, associate professor of medicine at Case Western Reserve University and an infectious disease physician at Louis Stokes Cleveland VA Medical Center, and colleagues wrote. “Although CDI is often diagnosed in LTCFs, the source of acquisition of C. difficile in these cases is not clear.”

Donskey and colleagues performed a cohort study over the course of 5 months, obtaining rectal swabs from patients at the time of transfer from VA hospitals to an affiliated LTCF and continuing weekly for 6 weeks. The researchers tracked cases of LTCF-onset CDI occurring within 1 month of transfer among patients who were colonized upon admission, comparing them with new cases of C. difficile acquired within the facility.

According to the researchers, 110 patients were transferred from the hospital to the LTCF during the study, 12 (11%) of whom had asymptomatic toxigenic C. difficile colonization upon admission. More than one-fourth (27%; n = 22) of 82 patients who had negative cultures on admission and at least one follow-up test acquired C. difficile, Donskey and colleagues wrote. Of these, four developed CDI within 1 month. Three cases were initial, and one was recurrent.

“We found that LTCF residents in our facility frequently acquired colonization with toxigenic C. difficile after transfer from the hospital, and most initial CDI cases with onset within 1 month of transfer occurred in residents who acquired colonization in the LTCF,” the researchers wrote. “Previous studies have demonstrated that LTCF residents frequently acquire colonization with other health-care associated pathogens, including multidrug-resistant gram-negative bacilli, vancomycin-resistant enterococci and methicillin-resistant Staphylococcus aureus. Thus, greater emphasis should be placed on infection control measures and antimicrobial stewardship in LTCFs as well as LTCF residents during hospital admissions.” – by Andy Polhamus

Disclosure: Donskey has received research grants from Merck, GOJO, EcoLab and Clorox and serves on an advisory board for 3M. All other authors report no relevant financial disclosures.

Patients who were transferred from a Veterans Affairs hospital to a long-term care facility were frequently colonized with Clostridium difficile after their transfer, according to findings recently published in Infection Control and Hospital Epidemiology.

Recent increases in the incidence of Clostridium difficile infection, or CDI, have been observed in all age groups, but the elderly have been disproportionately affected, and long-term care facilities (LTCFs) have borne a significant proportion of the increasing burden of CDI,” Curtis Donskey, MD, associate professor of medicine at Case Western Reserve University and an infectious disease physician at Louis Stokes Cleveland VA Medical Center, and colleagues wrote. “Although CDI is often diagnosed in LTCFs, the source of acquisition of C. difficile in these cases is not clear.”

Donskey and colleagues performed a cohort study over the course of 5 months, obtaining rectal swabs from patients at the time of transfer from VA hospitals to an affiliated LTCF and continuing weekly for 6 weeks. The researchers tracked cases of LTCF-onset CDI occurring within 1 month of transfer among patients who were colonized upon admission, comparing them with new cases of C. difficile acquired within the facility.

According to the researchers, 110 patients were transferred from the hospital to the LTCF during the study, 12 (11%) of whom had asymptomatic toxigenic C. difficile colonization upon admission. More than one-fourth (27%; n = 22) of 82 patients who had negative cultures on admission and at least one follow-up test acquired C. difficile, Donskey and colleagues wrote. Of these, four developed CDI within 1 month. Three cases were initial, and one was recurrent.

“We found that LTCF residents in our facility frequently acquired colonization with toxigenic C. difficile after transfer from the hospital, and most initial CDI cases with onset within 1 month of transfer occurred in residents who acquired colonization in the LTCF,” the researchers wrote. “Previous studies have demonstrated that LTCF residents frequently acquire colonization with other health-care associated pathogens, including multidrug-resistant gram-negative bacilli, vancomycin-resistant enterococci and methicillin-resistant Staphylococcus aureus. Thus, greater emphasis should be placed on infection control measures and antimicrobial stewardship in LTCFs as well as LTCF residents during hospital admissions.” – by Andy Polhamus

Disclosure: Donskey has received research grants from Merck, GOJO, EcoLab and Clorox and serves on an advisory board for 3M. All other authors report no relevant financial disclosures.