784 infection control & hospital epidemiology july 2018, vol. 39, no. 7


2.9% to 31.6% (95% CI, 3.0%–54.4%; P=.010) among dif- ferent nursing homes (Table 2). In the follow-up study, the demographic data of 153 residents from 4 nursing homes were collected. The univariate analysis showed that factors asso- ciated with C. difficile colonization were presence of hepatic disease (11.1% vs 0.7%; P=.037), history of hospitalization (61.1% vs 25.2%; P=.002), use of penicillin-group antibiotics within 12 weeks (38.9% vs 13.3%; P=.013), bedbound status (22.2% vs 5.3%; P=.028), and presence of nasogastric tube (22.2% vs 3%; P=.007) (Table 3). In a multivariable logistic regression model, the presence of a nasogastric tube was a risk factor for C. difficile colonization (aOR, 8.59; 95% CI, 1.18– 62.53; P=0.034). For the 141 residents having a minimum of 90 days of fol-


low-up, the median duration of residence in the nursing home was 2.6 years (range, 0.5–19.7 years), of which 7 residents were


table 1. Characteristics of 8 Nursing Homes in Hong Kong AB C Type Resident-to-staff ratio


Infection control staff, no. Nurse


Health assistant Staff training Residents >75 y old, % Environment cleansing agent


No. of residents sharing 1 handwashing facility


Provision of alcohol-based hand disinfectant


Nursing Home D


E F G H


Nonprivate Private Private Private Private Private Private Nonprivate Total 38/16


2.38:1 1


1


1 1


78 Yes


20.5 Yes


1 1


Chlorine Chlorine Chlorine Chlorine Chlorine Chlorine Chlorine Chlorine 4.8


63.4 36.0 Yes


95.3 14.6 Yes


84.9 32


Yes


95.6 15


Yes


70.4 26.8 Yes


5.5 Yes


table 2. Prevalence of Toxigenic Clostridium difficile Colonization and Acquisition Among Nursing Home Residents in Hong Kong Nursing Home


Variable No. of specimens, baseline


Toxigenic C. difficile prevalence, no. (%)


95% confidence interval A 32 B 19 35


C D 56


E 33 No. of patients in follow-up …… …… 185


Acquisitiona/Residents at riskb (%) …… …… 2/26 (7.7)


Acquisitiona per 1,000 resident days at riskc …… …… 0.256 F 56 299


5/44 (11.4) 0.396


G H Total 20


49 58


1/13 (7.7) 0.524


135


1/41 (2.4) 0.163


300 677


1 (3.1) 6 (31.6) 1 (2.9) 8 (14.3) 4 (12.1) 4 (7.1) 4 (20.0) 2 (4.1) 30 (10.0) 0.6–15.8 15.4–54.0 0.6–14.6 10.0–29.9 4.9–27.4 2.9–17.0 8.1–41.7 1.2–13.8 7.1–14.0


9/124 (7.3) 0.316


aOnly residents who had a minimum of 90 days of follow-up were included. A resident was defined as having new acquisition of C. difficile in the nursing home if a negative baseline stool culture was followed by a positive culture on subsequent visit. The resident should have no history of


hospitalization within the past 90 days of acquisition, or the stool culture after last hospitalization was negative. bResidents at risk were those whose stool cultures were C. difficile negative. cResident days at risk included the number of days of residence of the residents at risk; For residents who died or left the nursing homes between


visits, the resident days up to the last visit were included. For residents whose specimens converted from negative to positive, the resident days up to the specimen collection date were included.


N/A


0 2


0 1


1 1


3.10:1 2


0


Regular Once Regular Regular Regular Regular Regular Regular 92.1


94 77.3


41/11 72/13 190/90 96/23 45/11 214/69 149/48 845/281 3.73:1 5.54:1 2.11:1 4:17:1 4.09:1 3.10:1


3.01:1


newly admitted. Moreover, 124 residents (87.9%) were at risk of C. difficile acquisition in the nursing homes. Furthermore, 16 residents (12.9%) acquired C. difficile (9 of whom acquired toxigenic C. difficile) over a median follow-up duration of 29 weeks. The incidence of acquisition of C. difficile and toxi- genic C. difficile were 0.56 per 1,000 resident days at risk and 0.32 per 1,000 resident days at risk, respectively. No factors were associated with C. difficile acquisition. Overall, 41 resi- dents were carrying C. difficile during the study period: resi- dents who were C. difficile positive at baseline (N=17); residents who acquired C. difficile in nursing homes (N=16); and residents who became C. difficile positive after hospitali- zation (N=8). We excluded 6 residents due to intermittent positive specimens. Of the 35 residents with positive C. difficile culture included in the analysis, the Kaplan-Meier estimate of median carriage duration was 13 weeks (Figure 1).


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