title: Burden of Clostridium difficile infection in long-term care facilities in Monroe County, New York.
abstract: BACKGROUND
  Long-term care facility (LTCF) residents are at increased risk of Clostridium difficile infection (CDI). However, little is known about the incidence, recurrence, and severity of CDI in LTCFs or the extent to which acute care exposure contributes to CDI in LTCFs. We describe the epidemiology of CDI in a cohort of LTCF residents in Monroe County, New York, where recent estimates suggest a CDI incidence in hospitals of 9.2 cases per 10,000 patient-days.
  
  
  METHODS
  Population-based surveillance study.
  
  
  METHODS
  Monroe County, New York. Patients. LTCF residents with onset of CDI while in the LTCF or less than 4 calendar-days after hospital admission from the LTCF from January 1 through December 31, 2010.
  
  
  METHODS
  We conducted surveillance for CDI in residents of 33 LTCFs. A CDI case was defined as a stool specimen positive for C. difficile obtained from a patient without a C. difficile-positive specimen in the previous 8 weeks; recurrence was defined as a stool specimen positive for C. difficile obtained between 2 and 8 weeks after the last C. difficile-positive stool specimen.
  
  
  RESULTS
  There were 425 LTCF-onset cases and 184 recurrences, which yielded an incidence of 2.3 cases per 10,000 resident-days (interquartile range [IQR], 1.2-3.3) and a recurrence rate of 1.0 case per 10,000 resident-days (IQR, 0.3-1.4). The cases occurred in 394 LTCF residents, and 52% of these residents developed CDI within 4 weeks after hospital discharge. Hospitalization for CDI occurred in 70 cases (16%). Of those cases that involved hospitalization for CDI, 70% were severe CDI, and 23% ended in death within 30 days after hospital admission.
  
  
  CONCLUSIONS
  CDI incidence in Monroe County LTCFs is one-fourth the incidence among hospitalized patients. Approximately 50% of LTCF-onset cases occurred more than 4 weeks after hospital discharge, which emphasizes that prevention of CDI transmission should go beyond acute care settings.
authors.affiliation: Center for Community Health, University of Rochester, Rochester, New York, USA. dpawar@jhsph.edu
authors.forename: Deepa
authors.initials: D
authors.lastname: Pawar
authors.forename: Rebecca
authors.initials: R
authors.lastname: Tsay
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Nelson
authors.forename: Meena Kumari
authors.initials: MK
authors.lastname: Elumalai
authors.forename: Fernanda C
authors.initials: FC
authors.lastname: Lessa
authors.forename: L
authors.initials: L
authors.lastname: Clifford McDonald
authors.forename: Ghinwa
authors.initials: G
authors.lastname: Dumyati
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods; D012866:Skilled Nursing Facilities