title: Prevalence and impact of Clostridium difficile infection in elderly residents of long-term care facilities, 2011: A nationwide study.
abstract: The elderly population is particularly vulnerable to Clostridium difficile infection (CDI), but the epidemiology of CDI in long-term care facilities (LTCFs) is unknown.We performed a retrospective cohort study and used US 2011 LTCF resident data from the Minimum Data Set 3.0 linked to Medicare claims. We extracted CDI cases based on International Classification of Diseases-9 coding, and compared residents with the diagnosis of CDI to those who did not have a CDI diagnosis during their LTCF stay. We estimated CDI prevalence rates and calculated 3-month mortality rates.The study population consisted of 2,190,613 admissions (median age 82 years; interquartile range 76-88; female to male ratio 2:1; >80% whites), 45,500 of whom had a CDI diagnosis. The nationwide CDI prevalence rate was 1.85 per 100 LTCF admissions (95% confidence interval [CI] 1.83-1.87). The CDI rate was lower in the South (1.54%; 95% CI 1.51-1.57) and higher in the Northeast (2.29%; 95% CI 2.25-2.33). Older age, white race, presence of a feeding tube, unhealed pressure ulcers, end-stage renal disease, cirrhosis, bowel incontinence, prior tracheostomy, chemotherapy, and chronic obstructive pulmonary disease were independently related to "high risk" for CDI. Residents with a CDI diagnosis were more likely to be admitted to an acute care hospital (40% vs 31%, P < 0.001) and less likely to be discharged to the community (46% vs 54%, P < 0.001) than those not reported with CDI during stay. Importantly, CDI was associated with higher mortality (24.7% vs 18.1%, P = 0.001).CDI is common among the elderly residents of LTCFs and is associated with significant increase in 3-month mortality. The prevalence is higher in the Northeast and risk stratification can be used in CDI prevention policies.
authors: Department of Medicine, Warren Alpert Medical School Center for Gerontology and Healthcare Research, Brown University, Providence, RI Department of Health Care Policy, Harvard Medical School, Boston, MA Infectious Diseases Division, Warren Alpert Medical School, Brown University Providence Veterans Administration Medical Center, Center for Innovation (COIN), Providence, RI.
authors: Panayiotis D
authors: PD
authors: Ziakas
authors: Nina
authors: N
authors: Joyce
authors: Ioannis M
authors: IM
authors: Zacharioudakis
authors: Fainareti N
authors: FN
authors: Zervou
authors: Richard W
authors: RW
authors: Besdine
authors: Vincent
authors: V
authors: Mor
authors: Eleftherios
authors: E
authors: Mylonakis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000175:diagnosis / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D015577:Geriatric Assessment; D006707:Homes for the Aged; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D006278:Medicare; D009735:Nursing Homes; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D035862:Vulnerable Populations