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Clostridium difficile in an Urban, University-Affiliated Long-Term Acute-Care Hospital

Published online by Cambridge University Press:  07 December 2016

Jerry Jacob ,
Jingwei Wu ,
Jennifer Han  and
Deborah B. Nelson
Jerry Jacob*
Affiliation:
Department of Medicine, Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Jingwei Wu
Affiliation:
Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, Pennsylvania
Jennifer Han
Affiliation:
Department of Medicine, Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Deborah B. Nelson
Affiliation:
Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, Pennsylvania
*
Address correspondence to Dr Jerry Jacob, Good Shepherd Penn Partners, 1800 Lombard St, Philadelphia, PA 19146 (jerry.jacob@uphs.upenn.edu)
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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

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 3 , March 2017 , pp. 294 - 299
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

a

Authors of equal contribution.

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