C. difficile Infections in Long-Term Care Facilities Characterized

New baseline national data from Veterans Affairs long-term-care facilities could be used to develop effective ways to decrease infections.

SAN DIEGO — A large study of Veterans Affairs (VA) health system data presented at ID Week may offer insight into the epidemiology of Clostridium difficile infections (CDI) in long-term care facilities and guide development of CDI prevention efforts.

A nationwide initiative was implemented in February 2014 to decrease CDI in VA long-term-care facilities. 

Jeffrey Reeves, MD, of the University of Kentucky College of Medicine in Lexington and the Lexington VA Medical Center, and colleagues analyzed national CDI data collected during the 24 months prior to implementation of the initiative. From February 2012 through January 2014, personnel at each of 122 data reporting units entered monthly retrospective CDI case data into a central database. 

The researchers defined case onset as the time a stool was collected for C. difficile testing (LabID Event). They defined a community-onset healthcare facility associated (CO-HCFA) case as a positive LabID Event within 48 hours or less of admission plus a previous admission within 28 days or less; a CO-notHCFA case as a positive LabID Event within 48 hours or less of admission with no previous admission within 28 days or less; long-term-care facility onset HCFA (LO-HCFA) as a positive LabID Event more than 48 hours after admission; and clinical confirmed LO-HCFA (CC-LO-HCFA) as a LO-HCFA case with diarrhea or histopathologic or colonoscopic evidence of pseudomembranous colitis.

Among the 100,800 long-term-care facility admissions and 6,976,121 resident-days during the study period, the researchers identified 1,558 CDI cases. The pooled CDI admission prevalence rate (including recurrent cases) was 0.38 cases per 100 admissions, Dr. Reeves’ group reported.

The pooled non-duplicate/non-recurrent CO-notHCFA and CO-HCFA rates were 0.19 and 0.04 cases per 100 admissions, respectively, according to the researchers. The LO-HCFA, CC-LO-HCFA, and CO-HCFA rates were 1.98, 1.78, and 0.06 cases per 10,000 resident-days, respectively.

The researchers concluded that VA long-term-care facility CDI rates were comparable to those of other long-term-care facilities in the last decade and noted that the LO-HCFA rates found in the new study were markedly lower than the hospital-onset HCFA rates previously reported in VA acute care facilities.

In an interview with Infectious Disease Advisor, Erik R. Dubberke, MD, a co-moderator of the C. difficile session at which the new study was presented, noted that the study by Dr Reeves and his colleagues addresses an important epidemiologic knowledge gap. 

“We really do not have great data on C. difficile infection incidence in long-term-care facilities,” said Dr Dubberke, associate professor of medicine at Washington University School of Medicine in St. Louis. The baseline data that emerged from the study provide a starting point for developing effective CDI prevention efforts, he added.


1. Reeves J, Evans M, Simbartl L, et al. Oral abstract 71. Clostridium difficile Infections in Veterans Health Administration Long-Term Care Facilities.Presented at: ID Week 2015. Oct. 7-11, 2015. San Diego.