Burden of Clostridium difficile-associated diarrhea in a long-term care facility

OBJECTIVES: To describe the incidence and prevalence of Clostridium difficile-associated diarrhea (CDAD) in a long-term care facility (LTCF). DESIGN: Retrospective review of CDAD cases between July 2001 and December 2003. SETTING: Two hundred two-bed LTCF affiliated with an academic medical center in Baltimore, Maryland. PARTICIPANTS: All residents of the facility during July 2001 to December 2003. MEASUREMENTS: Clinical and laboratory-confirmed cases of CDAD. RESULTS: Incidence of CDAD ranged from 0 to 2.62 cases per 1,000 resident days. The highest rates were observed in residents of subacute units, whereas incidence was much lower on traditional nursing home units. Prevalence of CDAD at admission was greater on units (subacute and rehabilitative) where the majority of patients were admitted from hospital settings than on those where the majority of patients were admitted from the community (nursing home units). Recurrent disease occurred in 21.7% of patients with CDAD. CONCLUSION: CDAD remains a problem in the long-term care setting, and importation from the acute care setting accounts for a large proportion of the C. difficile seen LTCFs. As the population continues to age, issues of disease and infection in long-term care are expected to increase. New prevention and control strategies are needed to control the spread of CDAD in LTCFs.