Surveillance for Clostridium difficile infection in nursing homes

Area of Science:

• Infectious Diseases
• Epidemiology
• Healthcare-Associated Infections

Background:

• Clostridium difficile infection (CDI) is a significant concern in long-term care facilities.
• Accurate classification of CDI onset is crucial for effective surveillance and prevention strategies.

Purpose of the Study:

• To determine the timing of Clostridium difficile infection (CDI) onset in residents of community nursing homes.
• To evaluate the implications of current surveillance definitions for nursing home-associated CDI.

Main Methods:

• Retrospective study involving four community nursing homes.
• Identified incident CDI cases from infection control surveillance records.
• Classified cases based on onset within 30 days or more than 30 days after admission post-hospitalization.

Main Results:

• Out of 75 incident CDI cases, 69% occurred within 30 days of admission.
• A significant proportion (68%) of early-onset cases were in residents admitted for subacute care.
• The mean time to CDI onset for early cases was 10.5 ± 2.5 days, with 75% occurring within 15 days of admission.

Conclusions:

• The majority of nursing home CDI cases manifest within 30 days of admission.
• These early-onset cases may align with community-onset, hospital-associated CDI criteria.
• Current Centers for Disease Control and Prevention (CDC) surveillance definitions might overestimate nursing home-associated CDI incidence.