Clostridium difficile Colonization in Residents of Long‐Term Care Facilities: Prevalence and Risk Factors

Karla J. Walker, Susan S. Gilliland, Kyle Vance‐Bryan, Julia A. Moody, Alison J. Larsson, John C. Rotschafer, David R.P. Guay

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Abstract

Objective: To determine the period prevalence of Clostridium difficile disease and asymptomatic carriage in the residents of long‐term care facilities (LTCF) and to characterize the risk factors for colonization or associated disease. Design: Period prevalence survey. Setting: Two long‐term care facilities in St. Paul, MN. Participants: Specimens were collected from 225 LTCF residents. Measurements: The dependent variable was the culture result for C. difficile, which was isolated and identified using selective culture media and a commercial anaerobe identification kit. Tissue culture assay was used to detect the ability of each C. difficile isolate to produce toxin. Independent variables (including gender, age, race, current medical diagnoses, severity of underlying disease, case mix, current clinical symptoms, current medications, antibiotic use within 4 weeks prior to specimen procurement, and other pertinent history) were obtained from the current medical record of each participant. Results: Of 225 stool cultures that were obtained, 16 (7.1%) were positive for C. difficile. None of the residents with a positive culture was symptomatic. History of nosocomial infection and the use of antibiotics in general, cephalosporins, trimethoprim/sulfamethoxazole (TMP/SMX), and histamine‐2 blockers were significantly associated with positive C. difficile culture (P ≤ 0.05) by univariate analyses. Trends towards significance (0.05 < P < 0.10) were noted for narcotic use, previous hospitalization, LTCF, and non‐insulin‐dependent diabetes mellitus. Logistic regression analysis revealed significant, independent predictors of positive culture: antibiotic use in general (P = 0.028; relative risk = 3.31), histamine‐2 antagonist use (P = 0.038; relative risk = 3.27), cephalosporin use (P = 0.038; relative risk = 4.66), and TMP/SMX use (P = 0.007; relative risk = 8.45). Conclusions: The use of antibiotics, particularly cephalosporins and TMP/SMX, is a significant risk factor for asymptomatic carriage of C. difficile in long‐term care facilities. The use of H‐2 blockers was also a significant risk factor for carriage; however, this finding has not been reported previously and should be confirmed by independent studies. These medications should be used judiciously in the LTCF population. When diarrheal diseases are encountered in LTCF residents, a high index of suspicion for C. difficile infection should be maintained and the appropriate diagnostic and therapeutic measures taken. 1993 The American Geriatrics Society

Original languageEnglish (US)
Pages (from-to)940-946
Number of pages7
JournalJournal of the American Geriatrics Society
Volume41
Issue number9
DOIs
StatePublished - Jan 1 1993

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Clostridium difficile
Sulfamethoxazole Drug Combination Trimethoprim
Cephalosporins
Anti-Bacterial Agents
Clostridium Infections
Asymptomatic Diseases
Diagnosis-Related Groups
Narcotics
Cross Infection
Medical Records
Culture Media
Diabetes Mellitus
Hospitalization
Logistic Models
History
Regression Analysis
Population

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Clostridium difficile Colonization in Residents of Long‐Term Care Facilities : Prevalence and Risk Factors. / Walker, Karla J.; Gilliland, Susan S.; Vance‐Bryan, Kyle; Moody, Julia A.; Larsson, Alison J.; Rotschafer, John C.; Guay, David R.P.

In: Journal of the American Geriatrics Society, Vol. 41, No. 9, 01.01.1993, p. 940-946.

Research output: Contribution to journalArticle

Walker, Karla J. ; Gilliland, Susan S. ; Vance‐Bryan, Kyle ; Moody, Julia A. ; Larsson, Alison J. ; Rotschafer, John C. ; Guay, David R.P. / Clostridium difficile Colonization in Residents of Long‐Term Care Facilities : Prevalence and Risk Factors. In: Journal of the American Geriatrics Society. 1993 ; Vol. 41, No. 9. pp. 940-946.
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title = "Clostridium difficile Colonization in Residents of Long‐Term Care Facilities: Prevalence and Risk Factors",
abstract = "Objective: To determine the period prevalence of Clostridium difficile disease and asymptomatic carriage in the residents of long‐term care facilities (LTCF) and to characterize the risk factors for colonization or associated disease. Design: Period prevalence survey. Setting: Two long‐term care facilities in St. Paul, MN. Participants: Specimens were collected from 225 LTCF residents. Measurements: The dependent variable was the culture result for C. difficile, which was isolated and identified using selective culture media and a commercial anaerobe identification kit. Tissue culture assay was used to detect the ability of each C. difficile isolate to produce toxin. Independent variables (including gender, age, race, current medical diagnoses, severity of underlying disease, case mix, current clinical symptoms, current medications, antibiotic use within 4 weeks prior to specimen procurement, and other pertinent history) were obtained from the current medical record of each participant. Results: Of 225 stool cultures that were obtained, 16 (7.1{\%}) were positive for C. difficile. None of the residents with a positive culture was symptomatic. History of nosocomial infection and the use of antibiotics in general, cephalosporins, trimethoprim/sulfamethoxazole (TMP/SMX), and histamine‐2 blockers were significantly associated with positive C. difficile culture (P ≤ 0.05) by univariate analyses. Trends towards significance (0.05 < P < 0.10) were noted for narcotic use, previous hospitalization, LTCF, and non‐insulin‐dependent diabetes mellitus. Logistic regression analysis revealed significant, independent predictors of positive culture: antibiotic use in general (P = 0.028; relative risk = 3.31), histamine‐2 antagonist use (P = 0.038; relative risk = 3.27), cephalosporin use (P = 0.038; relative risk = 4.66), and TMP/SMX use (P = 0.007; relative risk = 8.45). Conclusions: The use of antibiotics, particularly cephalosporins and TMP/SMX, is a significant risk factor for asymptomatic carriage of C. difficile in long‐term care facilities. The use of H‐2 blockers was also a significant risk factor for carriage; however, this finding has not been reported previously and should be confirmed by independent studies. These medications should be used judiciously in the LTCF population. When diarrheal diseases are encountered in LTCF residents, a high index of suspicion for C. difficile infection should be maintained and the appropriate diagnostic and therapeutic measures taken. 1993 The American Geriatrics Society",
author = "Walker, {Karla J.} and Gilliland, {Susan S.} and Kyle Vance‐Bryan and Moody, {Julia A.} and Larsson, {Alison J.} and Rotschafer, {John C.} and Guay, {David R.P.}",
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T1 - Clostridium difficile Colonization in Residents of Long‐Term Care Facilities

T2 - Prevalence and Risk Factors

AU - Walker, Karla J.

AU - Gilliland, Susan S.

AU - Vance‐Bryan, Kyle

AU - Moody, Julia A.

AU - Larsson, Alison J.

AU - Rotschafer, John C.

AU - Guay, David R.P.

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N2 - Objective: To determine the period prevalence of Clostridium difficile disease and asymptomatic carriage in the residents of long‐term care facilities (LTCF) and to characterize the risk factors for colonization or associated disease. Design: Period prevalence survey. Setting: Two long‐term care facilities in St. Paul, MN. Participants: Specimens were collected from 225 LTCF residents. Measurements: The dependent variable was the culture result for C. difficile, which was isolated and identified using selective culture media and a commercial anaerobe identification kit. Tissue culture assay was used to detect the ability of each C. difficile isolate to produce toxin. Independent variables (including gender, age, race, current medical diagnoses, severity of underlying disease, case mix, current clinical symptoms, current medications, antibiotic use within 4 weeks prior to specimen procurement, and other pertinent history) were obtained from the current medical record of each participant. Results: Of 225 stool cultures that were obtained, 16 (7.1%) were positive for C. difficile. None of the residents with a positive culture was symptomatic. History of nosocomial infection and the use of antibiotics in general, cephalosporins, trimethoprim/sulfamethoxazole (TMP/SMX), and histamine‐2 blockers were significantly associated with positive C. difficile culture (P ≤ 0.05) by univariate analyses. Trends towards significance (0.05 < P < 0.10) were noted for narcotic use, previous hospitalization, LTCF, and non‐insulin‐dependent diabetes mellitus. Logistic regression analysis revealed significant, independent predictors of positive culture: antibiotic use in general (P = 0.028; relative risk = 3.31), histamine‐2 antagonist use (P = 0.038; relative risk = 3.27), cephalosporin use (P = 0.038; relative risk = 4.66), and TMP/SMX use (P = 0.007; relative risk = 8.45). Conclusions: The use of antibiotics, particularly cephalosporins and TMP/SMX, is a significant risk factor for asymptomatic carriage of C. difficile in long‐term care facilities. The use of H‐2 blockers was also a significant risk factor for carriage; however, this finding has not been reported previously and should be confirmed by independent studies. These medications should be used judiciously in the LTCF population. When diarrheal diseases are encountered in LTCF residents, a high index of suspicion for C. difficile infection should be maintained and the appropriate diagnostic and therapeutic measures taken. 1993 The American Geriatrics Society

AB - Objective: To determine the period prevalence of Clostridium difficile disease and asymptomatic carriage in the residents of long‐term care facilities (LTCF) and to characterize the risk factors for colonization or associated disease. Design: Period prevalence survey. Setting: Two long‐term care facilities in St. Paul, MN. Participants: Specimens were collected from 225 LTCF residents. Measurements: The dependent variable was the culture result for C. difficile, which was isolated and identified using selective culture media and a commercial anaerobe identification kit. Tissue culture assay was used to detect the ability of each C. difficile isolate to produce toxin. Independent variables (including gender, age, race, current medical diagnoses, severity of underlying disease, case mix, current clinical symptoms, current medications, antibiotic use within 4 weeks prior to specimen procurement, and other pertinent history) were obtained from the current medical record of each participant. Results: Of 225 stool cultures that were obtained, 16 (7.1%) were positive for C. difficile. None of the residents with a positive culture was symptomatic. History of nosocomial infection and the use of antibiotics in general, cephalosporins, trimethoprim/sulfamethoxazole (TMP/SMX), and histamine‐2 blockers were significantly associated with positive C. difficile culture (P ≤ 0.05) by univariate analyses. Trends towards significance (0.05 < P < 0.10) were noted for narcotic use, previous hospitalization, LTCF, and non‐insulin‐dependent diabetes mellitus. Logistic regression analysis revealed significant, independent predictors of positive culture: antibiotic use in general (P = 0.028; relative risk = 3.31), histamine‐2 antagonist use (P = 0.038; relative risk = 3.27), cephalosporin use (P = 0.038; relative risk = 4.66), and TMP/SMX use (P = 0.007; relative risk = 8.45). Conclusions: The use of antibiotics, particularly cephalosporins and TMP/SMX, is a significant risk factor for asymptomatic carriage of C. difficile in long‐term care facilities. The use of H‐2 blockers was also a significant risk factor for carriage; however, this finding has not been reported previously and should be confirmed by independent studies. These medications should be used judiciously in the LTCF population. When diarrheal diseases are encountered in LTCF residents, a high index of suspicion for C. difficile infection should be maintained and the appropriate diagnostic and therapeutic measures taken. 1993 The American Geriatrics Society

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