title: Clostridium difficile in an Urban, University-Affiliated Long-Term Acute-Care Hospital.
abstract: OBJECTIVES To describe the characteristics and impact of Clostridium difficile infection (CDI) in a long-term acute-care hospital (LTACH). DESIGN Retrospective matched cohort study. SETTING A 38-bed, urban, university-affiliated LTACH. METHODS The characteristics of LTACH-onset CDI were assessed among patients hospitalized between July 2008 and October 2015. Patients with CDI were matched to concurrently hospitalized patients without a diagnosis of CDI. Severe CDI was defined as CDI with 2 or more of the following criteria: age ≥65 years, serum creatinine ≥2 mg/dL, or peripheral leukocyte count ≥20,000 cells/μL. A conditional Poisson regression model was developed to determine characteristics associated with a composite primary outcome of 30-day readmission to an acute-care hospital, or mortality. RESULTS The overall incidence of CDI was 21.4 cases per 10,000 patient days, with 27% of infections classified as severe. Patients with CDI had a mean age of 70 years (SD, 14 years), a mean Charlson comorbidity index of 3.6 (SD, 2.0), a median length of stay of 33 days (interquartile range [IQR], 24-45 days), and a median time between admission and CDI diagnosis of 16 days (IQR, 9-23 days). The most commonly prescribed antibiotic preceding a CDI diagnosis was a cephalosporin, with median duration of 8 days (IQR, 4-14 days). In multivariate analysis, CDI was not significantly associated with the primary outcome (relative risk, 0.97; 95% CI, 0.59-1.58). CONCLUSIONS Incidence of CDI in an urban, university-affiliated LTACH was high. Future research should focus on infection prevention measures to decrease the burden of CDI in this complex patient population. Infect Control Hosp Epidemiol 2017;38:294-299.
authors.affiliation: 1Department of Medicine,Division of Infectious Diseases,Perelman School of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
authors.forename: Jerry
authors.initials: J
authors.lastname: Jacob
authors.affiliation: 2Department of Epidemiology and Biostatistics,College of Public Health,Temple University,Philadelphia,Pennsylvania.
authors.forename: Jingwei
authors.initials: J
authors.lastname: Wu
authors.affiliation: 1Department of Medicine,Division of Infectious Diseases,Perelman School of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Han
authors.affiliation: 2Department of Epidemiology and Biostatistics,College of Public Health,Temple University,Philadelphia,Pennsylvania.
authors.forename: Deborah B
authors.initials: DB
authors.lastname: Nelson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D002511:Cephalosporins / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000302:isolation & purification; D003015:Clostridium Infections / Q000188:drug therapy / Q000453:epidemiology*; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000706:statistics & numerical data*; D010414:Pennsylvania / Q000453:epidemiology; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins