Brown KA, et al. - Researchers here aimed at assessing a complete picture of C. difficile incidence and risk factors in acute and long-term care. Findings suggested that the main factor driving differences in C. difficile infection (CDI) incidence between acute and long-term care was facility-level antibiotic use. Compared to the importation of long-term care cases for acute care, importation of acute care C. difficile cases seemed a bigger concern for long-term care.

Methods

• A case-cohort study was planned of persons spending at least 3 days in one of 131 acute care or 120 long-term care facilities managed by the United States Veterans Health Administration between 2006 and 2012.
• This analysis included patient (n = 8) and facility factors (n = 5).
• The incidence of facility-onset laboratory-identified C. difficile infection (CDI), defined as a person with a positive C. difficile test without a positive test in the prior 8 weeks was the assessed outcome.

Results

• In acute care, CDI incidence was 5 times that observed in long-term care (median, 15.6 vs 3.2 per 10000 person-days).
• Acute care had greater history of antibiotic use in comparison to long-term care (median, 739 vs 513 per 1000 person-days) and this seemed explaining 72% of the variation in C. difficile rates.
• Observations revealed that importation of C. difficile cases (acute care: patients with recent long-term care attributable infection; long-term care: residents with recent acute care attributable infection) was 3 times higher in long-term care as compared to acute care (median, 52.3 vs 16.2 per 10000 person-days).