title: Burden of Clostridium difficile-associated diarrhea in a long-term care facility.
abstract: OBJECTIVE
  To describe the incidence and prevalence of Clostridium difficile-associated diarrhea (CDAD) in a long-term care facility (LTCF).
  
  
  METHODS
  Retrospective review of CDAD cases between July 2001 and December 2003.
  
  
  METHODS
  Two hundred two-bed LTCF affiliated with an academic medical center in Baltimore, Maryland.
  
  
  METHODS
  All residents of the facility during July 2001 to December 2003.
  
  
  METHODS
  Clinical and laboratory-confirmed cases of CDAD.
  
  
  RESULTS
  Incidence of CDAD ranged from 0 to 2.62 cases per 1,000 resident days. The highest rates were observed in residents of subacute units, whereas incidence was much lower on traditional nursing home units. Prevalence of CDAD at admission was greater on units (subacute and rehabilitative) where the majority of patients were admitted from hospital settings than on those where the majority of patients were admitted from the community (nursing home units). Recurrent disease occurred in 21.7% of patients with CDAD.
  
  
  CONCLUSIONS
  CDAD remains a problem in the long-term care setting, and importation from the acute care setting accounts for a large proportion of the C. difficile seen LTCFs. As the population continues to age, issues of disease and infection in long-term care are expected to increase. New prevention and control strategies are needed to control the spread of CDAD in LTCFs.
authors.affiliation: Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland 21224, USA. alaffan@jhsph.edu
authors.forename: Alison M
authors.initials: AM
authors.lastname: Laffan
authors.forename: Michelle F
authors.initials: MF
authors.lastname: Bellantoni
authors.forename: William B
authors.initials: WB
authors.lastname: Greenough
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Zenilman
mesh_terms: D000368:Aged; D015142:Baltimore; D003428:Cross Infection / Q000453:epidemiology; D003967:Diarrhea / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D007124:Immunoenzyme Techniques; D015994:Incidence; D017053:Infection Control; D008134:Long-Term Care; D009735:Nursing Homes; D015995:Prevalence; D012047:Rehabilitation Centers; D012112:Residential Facilities; D012189:Retrospective Studies; D019467:Subacute Care