Why do some patient care settings have higher rates of C. difficile infection?
New research discovered that the incidence of severe Clostridium difficile (C. difficile) infections and recurrences were more frequent in long-term care facilities compared to community residences.
Eleftherios Mylonakis, MD, PhD (photo), and a team from the Warren Alpert Medical School of Brown University studied 1,761 patients in long-term care facilities and community members to better understand C. difficile infection prevalence based on care facility stay, severity, site of management, and rate of recurrence. The research team added that C. difficile infection can be affected by hospitalization, antibiotic consumption, and advanced age — all similar factors to long-term care facility patients.
The patients involved in the study attended the Outpatient Parenteral Antibiotic Therapy Clinic of Rhode Island and The Miriam Hospitals between January 2013 and September 2015. The researchers defined infection as diarrhea with 3 or more unformed stools within 24 hours and a positive stool toxin assay or PCR.
Approximately 650 patients were residents of long term care facilities, while the rest were members of the community. About 22% of long-term care facility residents had C. difficile infection, while just 6.7% of community members were infected, according to the study authors. Among patients older than 65 years of age, infection prevalence was event higher: almost 26% among long-term care facility residents and about 9% of community residents.
The average age of community residents was 55 years and the age of long term care facility residents was 67 years. In the 18-64 years of age demographic, C. difficile infection was significantly different between communities and long-term care facility residents (5.5% and 19.4%, respectively).
For long-term care facility residents, the average length of stay was about 180 days, while the residents with C. difficile infection had a mean length of stay of nearly 295 days. The long-term care facility residents who did not have C. difficile infection only stayed in the facility about 148 days.
The researchers also reported that the medians of the 3 hospital exposure measures (number of hospital admissions, total hospitalization days, mean length of hospital stays) were not significantly different between the long-term care facility or community residents with C. difficile infection. There also did not appear to be a difference between the groups in terms of antibiotic consumption.
Long-term care facility residents were 3.25 times more likely to experience more severe infections compared to community residents. The researchers also determined that long-term care facility residents were admitted to the hospital for C. difficile infection more often than community residents disregarding factors such as age, hospital, and antibiotic exposure.
Almost half of long-term care facility patients with C. difficile infection were directly transferred to hospital facilities from a long-term care facility, about a quarter of C. difficile infected patients sought medical care within 3 days of long-term care facility discharge, and approximately 21% sought care within a week. Of the remaining patients, about 5% sought care within a month and the other 5% looked for care within 6 months from the long-term care facility discharge.
“Our study highlights the increased burden of C. difficile infection among long term care facility residents regardless of age, antibiotic, and hospitalization background, suggesting that urgent and effective prevention and beneficial strategies of early detection and management should be implemented in long term care facilities,” the study authors wrote, adding that the need for resistance potential antibiotics in turn contributed to antibiotic resistance in these facilities.
The study, published in the Journal of the American Geriatrics Society, was titled “The Attributable Burden of Clostridium difficile Infection to Long-Term Care Facilities Stay.”