C. difficile infection (CDI) in a long-term acute care facility (LTAC)

Background: C difficile infection (CDI) is a common nosocomial infection in hospitals and impacts increased hospital cost and length of stay. Since scant information is available about the incidence and prevalence of CDI in Long-term acute care hospitals (LTACs), we therefore studied this at one local facility. Methods: Demographic and other data, and a fresh stool sample were obtained from all new LTAC admissions not carrying a prior diagnosis of CDI during the study period (July 23 to August 22, 2007). A GDH test for C. difficile antigen was performed. All initially positive stools were tested for toxins A and B and a sample was frozen for culture and typing. All antigen-negative patients were monitored for the development of diarrhea during the course of their LTAC hospitalization and, if clinically indicated, a sample was sent for toxins A and B testing and if positive, a stool sample was frozen and stored for culture and typing. Therapy of CDI was noted. Results: 36 patients were admitted during the study period. 4 of 31 (12.9%) of patients tested were antigen (+) on admission of which 2 (6.5%) were asymptomatic carriers and 2 (6.5%) had unsuspected active disease, including one with the BI epidemic strain. In follow-up, 20/36 (55.5%) developed diarrhea of which an additional 5 (13.8%) patients had developed CDI (average, hospital day 38) in the hospital. Therapy was instituted with vancomycin in 5/7 patients and metronidazole in 2/7 patients. During that quarter, the rate of nosocomial acquired CDI was 3.12 per 1000 patient days. Conclusions: C. difficile carriage and unsuspected clinical CDI occurs, including with the BI epidemic strain disease, in an important minority of patients, which may act as a reservoir for spread. New strategies for detection and prevention of CDI are needed. (C) 2009 Elsevier Ltd. All rights reserved.