title: Do admissions and discharges to long-term care facilities influence hospital burden of Clostridium difficile infection?
abstract: BACKGROUND
  Substantial geographical clustering of Clostridium difficile infection (CDI) outbreaks in hospitals in the USA have previously been demonstrated.
  
  
  OBJECTIVE
  To test the hypothesis that hospital burden of CDI is associated with admission from and discharge to long-term care facilities (LTCFs).
  
  
  METHODS
  Hospital discharge data from 19 states in the USA were used to identify all patients discharged with a diagnosis of CDI from 1 January 2002 to 31 December 2004. For every hospital, the proportion of discharges with a diagnosis of CDI was calculated, and those above the 90th percentile were classified as 'high CDI' hospitals. We tested the association between this measure of hospital burden of CDI and the rates of admission from and discharges to LTCFs. We adjusted for other hospital level characteristics, case-complexity and local population characteristics.
  
  
  RESULTS
  We identified 38,372,951 discharges during the three-year study period. Of all discharges, 274,311 (0.71%) had a primary or secondary diagnosis of CDI. Hospitals had a mean CDI burden of 7.8 cases per 1000 discharges. High CDI hospitals (N = 610; 10.0%) had a mean CDI burden of 34.8 cases per 1000 discharges. Compared to other hospitals, high CDI hospitals were more likely to have a high proportion of admissions from or discharges to LTCFs. This association persisted after adjustments for other hospital characteristics, case-complexity, and area population characteristics.
  
  
  CONCLUSIONS
  A high rate of admission from or discharge to LTCFs is associated with an increased hospital burden of CDI.
authors.affiliation: Department of Colon and Rectal Surgery, Lahey Clinic, Burlington, Massachusetts 01804, USA. Rocco.ricciardi@lahey.org
authors.forename: R
authors.initials: R
authors.lastname: Ricciardi
authors.forename: J
authors.initials: J
authors.lastname: Nelson
authors.forename: J L
authors.initials: JL
authors.lastname: Griffith
authors.forename: T W
authors.initials: TW
authors.lastname: Concannon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology*; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D006761:Hospitals; D006801:Humans; D008134:Long-Term Care; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D015995:Prevalence; D014481:United States / Q000453:epidemiology