Surveillance for clostridium difficile infection in nursing homes

Objectives: To define the time of onset of Clostridium difficile infection (CDI) in the community nursing home setting. Design: Retrospective. Setting: Four community nursing homes. Participants: Residents with incident CDI identified from infection control surveillance records. Measurements: Cases were divided into two groups depending on the time of onset of infection: within 30 days of admission after hospitalization or more than 30 days after admission to a nursing home after hospitalization. Results: Of 75 incident CDI cases, 52 (69%) developed within 30 days of admission and 23 (31%) more than 30 days after admission. Of the 52 cases that developed within 30 days, 68% were in residents admitted for subacute care. The mean number of days ± standard deviation to CDI was 10.5 ± 2.5 in those who developed infection within 30 days; 75% of these cases developed within 15 days of admission. Conclusions: The majority of CDI in the study nursing homes developed within 30 days of admission; this group may be analogous to community-onset, hospital-associated CDI as defined in the Centers for Disease Control and Prevention (CDC) surveillance definitions. Therefore, the proposed CDC surveillance definitions may overestimate the incidence of nursing home-associated CDI.