c.diff colonization of nursing home residents 1267
Clostridium difficile Colonization of Nursing Home Residents
To the Editor—Clostridum difficile is a leading cause of infec- tious diarrhea in nursing homes.1 Evidence-based infection control guidelines are needed to reduce transmission of C. difficile in nursing homes. These guidelines should account for the prevalence of C. difficile in the nursing home environ- ment. The primary objective of this project was to assess the proportion of nursing home residents colonized with toxigenic C. difficile. A random sample of community-based nursing home
residents (n=40; 10%) and Veterans Affairs Community Living Center (VA CLC) residents (n=40; 20%) were selected retrospectively from 2 cohort studies on MRSA colonization and transmission.2,3 The studies enrolled 401 residents from 13 community-based nursing homes in Maryland and Michigan and 200 residents from 5VACLCs in 4 states and the District of Columbia. Selection within the community-based facilities was designed to be representative of all nursing home residents. However, in the VA CLCs, 2 groups of residents were enrolled: residents with a recent (within 1 year) history of MRSA colonization and residents without recent MRSA colonization. All VA CLC residents with recent MRSA colo- nization were approached for enrollment. A random sample of residents without recent MRSA colonization was approached for enrollment to provide a representative sample. Specimens from the perianal skin were taken from enrolled residents. Notably, diarrhea was reported for 2%–3% of the study participants. No C. difficile outbreaks were reported during the studies.
Culture-based methods were used to detect toxigenic
C. difficile in perianal swabs. Resident swabs from the perianal skin were placed in cycloserine cefoxitin mannitol broth with taurocholate and lysozyme broth (Anaerobe Systems; Morgan Hill, CA) at 35°C in anaerobic conditions, and growth was observed at 24 hours, 48 hours, and 7 days. If growth was observed, the culture was transferred to a blood agar plate and incubated in aerobic conditions at 35°C for 48 hours. Any bacteria growth was identified using RapID Ana II system (Remel, Lenexa, KS). Toxins A and B and C. difficile glutamate dehydrogenase detection were determined using C Diff Quik Chek Complete kits (TechLab, Blacksburg, VA).4 Among the community-based nursing homes residents, 1 of
40 residents had perianal skin swabs that tested positive for toxigenic C. difficile (2.5%; 95% CI, 0.1%–13.2%). None of the 40 VA CLC residents tested positive for toxigenic C. difficile (0%; 95% CI, 0.0%–8.8%). These rates are slightly lower than those reported in the
literature. Based on data from 9 eligible studies that included 1,371 subjects, a recent systematic review found that 14.8% (95% CI, 7.6%–24.0%) of LTCF residents are asymptomatic carriers of toxigenic C. difficile.5 The systematic review included
21 LTCFs across 4 countries and 4 states. In contrast, our populations covered 18 nursing homes in 6 states. The facilities in the review with the highest reported rates of C. difficile colonization had also experienced recent outbreaks of C. difficile infection, which increased their estimates. Our results should reassure nursing homes that prevalence of toxigenic C. difficile is low during endemic periods. Standard precautions should be sufficient to prevent transmission under nonepidemic conditions.
acknowledgments
Financial support. This work was funded through the University of Maryland’s CDC EpiCenter (grant no. 1U54CK000450), an Agency for Healthcare Quality and Research (AHRQ) award (grant no. 1R18HS019979-01A1), and a Merit Review Award (grant no. #IIR10-154) from the US Department of Veterans Affairs Health Services Research and Development Service. Student support for E.M.S. was provided by an NIGMS Initiative for Maximizing Student Development grant (grant no. 2 R25-GM55036). Potential conflicts of interest. All authors report no conflicts of interest
relevant to this article. Disclaimer. The contents do not represent the views of the US Department of Veterans Affairs or the US Government. Clinical Trial Registration No.: NCT01350479.
Mary-Claire Roghmann, MD, MS;1,2 Liana R. Andronescu, MPH;1 Emily M. Stucke, BA;1 J. Kristie Johnson, PhD3
Affiliations: 1. Department of Epidemiology and Public Health, University
of Maryland School of Medicine, Baltimore, Maryland; 2. Geriatrics Research Education and Clinical Center, Veterans Affairs Maryland Health Care System, Baltimore, Maryland; 3. Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland. Address correspondence to Mary-Claire Roghmann, MD, MS, University of Maryland School of Medicine, 10 South Pine Street, MTSF Room 336, Baltimore, MD 21201 (
mroghman@epi.umaryland.edu). Infect Control Hosp Epidemiol 2017;38:1267–1268 © 2017 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2017/3810-0025. DOI: 10.1017/ice.2017.172
references
1. Jump RLP, Donskey CJ. Clostridium difficile in the long-term care facility: prevention and management. Curr Geriatr Rep 2015;4:60–69.
2. Roghmann MC, Johnson JK, Sorkin JD, et al. Transmission of methicillin-resistant Staphylococcus aureus (MRSA) to healthcare worker gowns and gloves during care of nursing home residents. Infect Control Hosp Epidemiol 2015;36:1050–1057.
3. Pineles L, Morgan DJ, Lydecker A, et al. Transmission of methicillin-resistant Staphylococcus aureus to health care worker gowns and gloves during care of residents in Veterans Affairs nursing homes. Am J Infect Control 2017. doi: 10.1016/ j.ajic.2017.03.004.
4. Hink T, Burnham CD, Dubberke ER. A systematic evaluation of methods to optimize culture-based recovery of Clostridium difficile from stool specimens. Anaerobe 2013;19:39–43.
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100 |
Page 101 |
Page 102 |
Page 103 |
Page 104 |
Page 105 |
Page 106 |
Page 107 |
Page 108 |
Page 109 |
Page 110 |
Page 111 |
Page 112 |
Page 113 |
Page 114 |
Page 115 |
Page 116 |
Page 117 |
Page 118 |
Page 119 |
Page 120 |
Page 121 |
Page 122 |
Page 123 |
Page 124 |
Page 125 |
Page 126 |
Page 127 |
Page 128 |
Page 129 |
Page 130 |
Page 131 |
Page 132 |
Page 133 |
Page 134 |
Page 135 |
Page 136 |
Page 137 |
Page 138 |
Page 139 |
Page 140 |
Page 141 |
Page 142 |
Page 143 |
Page 144
