Antibiotic Use, Antimicrobial Stewardship May Reduce C Difficile Rate in Long-Term Care Facilities
Antibiotic use and importation of infection from acute care facilities account for three-quarters of the regional variation in the incidence of Clostridium difficile at Veterans Health Administration long-term care facilities, according to a study in the online Annals of Internal Medicine.
“Only 25% of the variation in regional C difficile incidence in long-term care remained unexplained after importation from acute care facilities and antibiotic use were accounted for,” researchers wrote, “which suggests that improved infection control and antimicrobial stewardship may help reduce the incidence of C difficile in long-term care settings.”
The study, funded by the US Department of Veterans Affairs and the Centers for Disease Control and Prevention, investigated individual and regional factors affecting C difficile incidence in long-term care. Researchers analyzed patient factors such as age, number of comorbid conditions, and antibiotic exposure, as well as regional factors including importation of cases of acute care infection per 10,000 resident-days and antibiotic use per 1000 resident-days.
The study identified 6012 cases of C difficile infection across 86 Veterans Health Administration regions between 2006 and 2012. The overall incidence was 3.7 cases per 10,000 resident-days.
Across regions, incidence of C difficile, antibiotic use, and importation of acute care C difficile varied considerably, researchers reported. Specifically, C difficile incidence ranged from 0.6 cases to 31 cases per 10,000 resident-days; antibiotic use ranged from 61 days to 370.2 days with therapy per 1000 resident-days; and importation ranged from 2.9 cases to 341.3 cases per 10,000 resident-days.—Jolynn Tumolo
Reference
Brown KA, Jones M, Daneman N, et al. Importation, antibiotics, and clostridium difficile infection in veteran long-term care: a multilevel case-control study [published online ahead of print April 19, 2016]. Annals of Internal Medicine. doi:10.7326/M15-1754.
