title: The Attributable Burden of Clostridium difficile Infection to Long-Term Care Facilities Stay: A Clinical Study.
abstract: BACKGROUND
  Advanced age, history of hospitalization, and antibiotic consumption are associated with the pathogenesis of Clostridium difficile infection (CDI). Long-term care facilities (LTCFs) represent a setting where CDI has been increasingly reported. We aimed to estimate the actual attributable burden of CDI to LTCF stay and determine the characteristics of the disease epidemiology in this setting.
  
  
  METHODS
  IRB-approved retrospective cohort study.
  
  
  METHODS
  LTCF and community.
  
  
  METHODS
  One thousand seven hundred and sixty-one patients.
  
  
  RESULTS
  The prevalence of CDI among LTCF residents was 22.4%, whereas the prevalence of CDI among community residents was 6.7% (P < .001). The prevalence of CDI among LTCF residents was significantly higher in both the 18-64 (P < .001) and the ≥65 age groups (P < .010). Measures of hospital exposure and antibiotic consumption between LTCF and community residents prior to CDI diagnosis were non-significant. A strict matching (1:2) between LTCF and community residents adjusting for age, total number of hospital admissions and antibiotic consumption showed that the odds of CDI for an LTCF resident were 6.89 times larger than the odds for a community resident (OR = 6.89, 95%, 4.67-10.17). For an LTCF resident with CDI, the odds of manifesting severe disease were 3.25 times larger than the odds for a community resident with CDI (OR = 3.25, 95%, 1.81-5.86). LTCF residents were more frequently hospitalized (P = .002) required longer hospital stays for their CDI management (P = .03) and had more recurrent CDI cases than community residents (P = .04).
  
  
  CONCLUSIONS
  Our study highlights the increased burden of CDI among LTCF residents independently of age, antibiotic, and hospitalization background. Severe CDI disease and recurrences are more frequent in LTCFs.
authors.affiliation: Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island.
authors.forename: Styliani
authors.initials: S
authors.lastname: Karanika
authors.affiliation: Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island.
authors.forename: Christos
authors.initials: C
authors.lastname: Grigoras
authors.affiliation: Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island.
authors.forename: Myrto E
authors.initials: ME
authors.lastname: Flokas
authors.affiliation: Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island.
authors.forename: Michail
authors.initials: M
authors.lastname: Alevizakos
authors.affiliation: Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island.
authors.forename: Tori
authors.initials: T
authors.lastname: Kinamon
authors.affiliation: Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island.
authors.forename: Erna M
authors.initials: EM
authors.lastname: Kojic
authors.affiliation: Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island.
authors.forename: Eleftherios
authors.initials: E
authors.lastname: Mylonakis
mesh_terms: D000368:Aged; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000175:diagnosis / Q000453:epidemiology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D057187:Independent Living / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008134:Long-Term Care / Q000706:statistics & numerical data*; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: Clostridium difficile Infection; long-term care facilities; matched cohort study; prevalence; severity