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Nursing home-onset CDI associated with high morbidity, mortality

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PHILADELPHIA — Clostridium difficile infections, or CDIs, that occur in nursing home settings are associated with significant morbidity and mortality, according to research data presented at IDWeek 2014.

“Twenty-six percent of C. difficile in 2010 occurred in nursing homes,” Fernanda C. Lessa, MD, of the division of health care quality promotion at the CDC’s National Center for Emerging and Zoonotic Infectious Diseases, said in a presentation. “Nursing home residents are at increased risk of CDI due to advanced age, frequent hospitalization, extended length of stay and exposure to antimicrobials.”

Lessa and colleagues evaluated population-based surveillance data from 348 nursing homes in 10 US regions to estimate the incidence, recurrence, hospitalization and death among patients with nursing home-onset CDI.

Of 3,513 cases identified, 272 had a full medical record review; among those patients, the median age was 82 years, 60% were women, 77% had received antibiotics in the 12 weeks before positive stool specimen and 57% were discharged from a hospital in the month before positive stool specimen. The national estimate for annual nursing home-onset CDI (adjusted for age and diagnostic technique) was 115,811 cases (95% CI, 97,159-134,121), which included an estimated 31,644 who were hospitalized within a week of positive stool sample (95% CI, 25,875-37,415); 21,103 recurrent cases 14 to 60 days after prior positive stool sample (95% CI, 14,720-27,487); and 9,053 deaths within 30 days (95% CI, 6,874-11,231).

“In summary, nursing home CDI is associated with substantial morbidity and mortality,” Lessa said. “Approximately 115,000 nursing home CDI cases occurred in 2012 in the US, resulting in 31,000 hospitalizations and 9,000 deaths. Most patients were exposed to antibiotics, and had onset of the disease within a month after discharge. Strategies to reduce antibiotic use in acute and long-term care settings may lead to decreases in CDI with onset in nursing homes in the US.”

For more information:

Hunter JC. Abstract 524. Presented at: IDWeek; Oct. 8-12, 2014; Philadelphia.

Disclosure: See the abstract for a full list of relevant financial disclosures.