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Clostridium difficile in the Long-Term Care Facility: Prevention and Management

  • Infectious Diseases in the Elderly (KS Kaye and D Kaye, Section Editors)
  • Published:
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Abstract

Residents of long-term care facilities are at high risk for Clostridium difficile infection due to frequent antibiotic exposure in a population already rendered vulnerable to infection due to advanced age, multiple comorbid conditions and communal living conditions. Moreover, asymptomatic carriage of toxigenic C. difficile and recurrent infections are prevalent in this population. Here, we discuss epidemiology and management of C. difficile infection among residents of long-term care facilities (LTCFs). Also, recognizing that both the population and culture differ significantly from those in hospitals, we also address prevention strategies specific to LTCFs.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Dubberke ER, Carling P, Carrico R, Donskey CJ, Loo VG, McDonald LC, et al. Strategies to prevent Clostridium difficile infections in acute care Hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35:628–45. These are the latest infection control-related guidelines published by the Society for Healthcare Epidemiology of America. While not specific for long-term care facilities, the basic principles outlined for hospitals offer general guidance.

    Article  PubMed  Google Scholar 

  2. Magill SS, Edwards JR, Bamberg W, Beldavs ZG, Dumyati G, Kainer MA, et al. Multistate point-prevalence survey of health care–associated infections. N Engl J Med. 2014;370:1198–208.

    Article  CAS  PubMed  Google Scholar 

  3. Threat Report 2013 | Antimicrobial Resistance | CDC; available at http://www.cdc.gov/drugresistance/threat-report-2013/index.html. This is a comprehensive and detailed summary of consequences of antimicrobial resistant organisms as well as C. difficile for the United States. It summarizes morbidity, mortality and costs. Information is easily accessible and single pages may be extracted to support education of staff, residents and family members.

  4. Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). Infect Control Hosp Epidemiol Off J Soc Hosp Epidemiol Am. 2010;31:431–55. These are the current clinical guidelines published by the Infectious Disease Society of American and Society for Healthcare Epidemiology of America. An update is in progress with publication projected for Spring 2015.

    Article  Google Scholar 

  5. Surawicz CM, Brandt LJ, Binion DG, Ananthakrishnan AN, Curry SR, Gilligan PH, et al. Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. Am J Gastroenterol. 2013;108:478–98. Current clinical guidelines published by the American College of Gastroenterology.

    Article  CAS  PubMed  Google Scholar 

  6. Bauer MP, Kuijper EJ, Van Dissel JT. European Society of Clinical Microbiology and Infectious Diseases (ESCMID): treatment Guidance Document for Clostridium Difficile Infection (CDI). Clin Microbiol Infect. 2009;15:1067–79.

    Article  CAS  PubMed  Google Scholar 

  7. Rao A, Jump RLP, Pultz NJ, Pultz MJ, Donskey CJ. In vitro killing of nosocomial pathogens by acid and acidified nitrite. Antimicrob Agents Chemother. 2006;50:3901–4.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Marler LM, Siders JA, Wolters LC, Pettigrew Y, Skitt BL, Allen SD. Comparison of five cultural procedures for isolation of Clostridium difficile from stools. J Clin Microbiol. 1992;30:514–6.

    CAS  PubMed Central  PubMed  Google Scholar 

  9. Kim KH, Fekety R, Batts DH, Brown D, Cudmore M, Silva J, et al. Isolation of Clostridium difficile from the environment and contacts of patients with antibiotic-associated colitis. J Infect Dis. 1981;143:42–50.

    Article  CAS  PubMed  Google Scholar 

  10. Lawley TD, Walker AW. Intestinal colonization resistance. Immunology. 2013;138:1–11.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Zilberberg MD, Shorr AF, Kollef MH. Increase in adult Clostridium difficile-related hospitalizations and case-fatality rate, United States, 2000-2005. Emerg Infect Dis. 2008;14:929–31.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Loo VG, Poirier L, Miller MA, Oughton M, Libman MD, Michaud S, et al. A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med. 2005;353:2442–9.

    Article  CAS  PubMed  Google Scholar 

  13. McDonald LC, Killgore GE, Thompson A, Owens RC, Kazakova SV, Sambol SP, et al. An epidemic, toxin gene–variant strain of Clostridium difficile. N Engl J Med. 2005;353:2433–41.

    Article  CAS  PubMed  Google Scholar 

  14. Linder JA, Huang ES, Steinman MA, Gonzales R, Stafford RS. Fluoroquinolone prescribing in the United States: 1995 to 2002. Am J Med. 2005;118:259–68.

    Article  PubMed  Google Scholar 

  15. Lee GC, Reveles KR, Attridge RT, Lawson KA, Mansi IA, Lewis JS, et al. Outpatient antibiotic prescribing in the United States: 2000 to 2010. BMC Med. 2014;12:96.

    Article  PubMed Central  PubMed  Google Scholar 

  16. He M, Miyajima F, Roberts P, Ellison L, Pickard DJ, Martin MJ, et al. Emergence and global spread of epidemic healthcare-associated Clostridium difficile. Nat Genet. 2013;45:109–13.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Jabbari S, Cartman ST, King JR. 2014. Mathematical modelling reveals properties of TcdC required for it to be a negative regulator of toxin production in Clostridium difficile. J. Math. Biol. doi:10.1007/s00285-014-0780-0.

  18. Warny M, Pepin J, Fang A, Killgore G, Thompson A, Brazier J, et al. Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe. Lancet. 2005;366:1079–84.

    Article  CAS  PubMed  Google Scholar 

  19. Merrigan M, Venugopal A, Mallozzi M, Roxas B, Viswanathan VK, Johnson S, et al. Human hypervirulent Clostridium difficile strains exhibit increased sporulation as well as robust toxin production. J Bacteriol. 2010;192:4904–11.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Cartman ST, Kelly ML, Heeg D, Heap JT, Minton NP. Precise manipulation of the Clostridium difficile chromosome reveals a lack of association between the tcdC genotype and toxin production. Appl Environ Microbiol. 2012;78:4683–90.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Bacci S, Mølbak K, Kjeldsen MK, Olsen KEP. Binary toxin and death after Clostridium difficile infection. Emerg Infect Dis. 2011;17:976–82.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Stewart DB, Berg A, Hegarty J. Predicting recurrence of C. Difficile colitis using bacterial virulence factors: binary toxin is the key. J Gastrointest Surg. 2013;17:118–25.

    Article  PubMed  Google Scholar 

  23. Kaiser E, Kroll C, Ernst K, Schwan C, Popoff M, Fischer G, et al. Membrane translocation of binary actin-adp-ribosylating toxins from clostridium difficile and clostridium perfringens is facilitated by cyclophilin A and Hsp90. Infect Immun. 2011;79:3913–21.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Lucado J, Gould C, Elixhauser A. Clostridium difficile Infections (CDI) in Hospital Stays, 2009—Healthcare Cost and Utilization Project (HCUP) Statistical Briefs #124. January 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.hcupus.ahrq.gov/reports/statbriefs/sb124.pdf.

  25. McFarland LV, Mulligan ME, Kwok RY, Stamm WE. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med. 1989;320:204–10.

    Article  CAS  PubMed  Google Scholar 

  26. Dubberke ER. Attributable outcomes of endemic clostridium difficile-associated disease in nonsurgical patients. Emerg Infect Dis. 2008;14:1031–8.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Black SR, Weaver KN, Jones RC, Ritger KA, Petrella LA, Sambol SP, et al. Clostridium difficile outbreak strain BI is highly endemic in Chicago area hospitals. Infect Control Hosp Epidemiol. 2011;32:897–902.

    Article  PubMed  Google Scholar 

  28. Mylotte JM. Surveillance for Clostridium difficile-associated diarrhea in long-term care facilities: what you get is not what you see. Infect Control Hosp Epidemiol Off J Soc Hosp Epidemiol Am. 2008;29:760–3.

    Article  Google Scholar 

  29. Guerrero DM, Nerandzic MM, Jury LA, Chang S, Jump RL, Donskey CJ. Clostridium difficile infection in a Department of Veterans Affairs long-term care facility. Infect Control Hosp Epidemiol. 2011;32:513–5.

    Article  PubMed  Google Scholar 

  30. Archbald-Pannone LR, Boone JH, Carman RJ, Lyerly DM, Guerrant RL. 2014. Clostridium difficile ribotype 027 is most prevalent among inpatients admitted from long-term care facilities. J. Hosp. Infect. doi:10.1016/j.jhin.2014.06.016.

  31. Mylotte JM, Russell S, Sackett B, Vallone M, Antalek M. Surveillance for Clostridium difficile infection in nursing homes. J Am Geriatr Soc. 2013;61:122–5.

    Article  PubMed  Google Scholar 

  32. Vital signs: preventing clostridium difficile infections.

  33. 2012. Laboratory-identified Multidrug-Resistant Organism (MDRO) & Clostridium difficile Infection (CDI) Events for Long-term Care Facilities. http://www.cdc.gov/nhsn/PDFs/LTC/LTCF-LabID-Event-Protocol_FINAL_8-24-12.pdf. Accessed 18 June 2014.

  34. Gase KA, Haley VB, Xiong K, Antwerpen CV, Stricof RL. Comparison of 2 Clostridium difficile surveillance methods: national healthcare safety network’s laboratory-identified event reporting module versus clinical infection surveillance. Infect Control Hosp Epidemiol. 2013;34:284–90.

    Article  PubMed  Google Scholar 

  35. Han A, Jump RLP. Discrepancies between surveillance definition and the clinical incidence of Clostridium difficile infection in a VA long-term care facility. Infect Control Hosp Epidemiol in press.

  36. Campbell RJ, Giljahn L, Machesky K, Cibulskas-White K, Lane LM, Porter K, et al. Clostridium difficile infection in Ohio hospitals and nursing homes during 2006. Infect Control Hosp Epidemiol Off J Soc Hosp Epidemiol Am. 2009;30:526–33.

    Article  Google Scholar 

  37. Laffan AM, Bellantoni MF, Greenough 3rd WB, Zenilman JM. Burden of Clostridium difficile-associated diarrhea in a long-term care facility. J Am Geriatr Soc. 2006;54:1068–73.

    Article  PubMed  Google Scholar 

  38. Loo VG, Bourgault A-M, Poirier L, Lamothe F, Michaud S, Turgeon N, et al. Host and pathogen factors for Clostridium difficile infection and colonization. N Engl J Med. 2011;365:1693–703.

    Article  CAS  PubMed  Google Scholar 

  39. Jump RL. Clostridium difficile infection in older adults. Aging Health. 2013;9:403–14.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  40. Dial S, Delaney JAC, Barkun AN, Suissa S. Use of gastric acid-suppressive agents and the risk of community-acquired Clostridium difficile-associated disease. JAMA. 2005;294:2989–95.

    Article  CAS  PubMed  Google Scholar 

  41. Dubberke ER, Reske KA, Yan Y, Olsen MA, McDonald LC, Fraser VJ. Clostridium difficile-associated disease in a setting of endemicity: identification of novel risk factors. Clin Infect Dis Off Publ Infect Dis Soc Am. 2007;45:1543–9.

    Article  Google Scholar 

  42. Al-Tureihi FIJ, Hassoun A, Wolf-Klein G, Isenberg H. Albumin, length of stay, and proton pump inhibitors: key factors in Clostridium difficile-associated disease in nursing home patients. J Am Med Dir Assoc. 2005;6:105–8.

    Article  PubMed  Google Scholar 

  43. Eyre DW, Walker AS, Wyllie D, Dingle KE, Griffiths D, Finney J, et al. Predictors of first recurrence of Clostridium difficile infection: implications for initial management. Clin Infect Dis Off Publ Infect Dis Soc Am. 2012;55 Suppl 2:S77–87.

    Article  CAS  Google Scholar 

  44. Guerrero DM, Nerandzic MM, Jury LA, Jinno S, Chang S, Donskey CJ. Acquisition of spores on gloved hands after contact with the skin of patients with Clostridium difficile infection and with environmental surfaces in their rooms. Am J Infect Control. 2012;40:556–8.

    Article  PubMed  Google Scholar 

  45. Vesteinsdottir I, Gudlaugsdottir S, Einarsdottir R, Kalaitzakis E, Sigurdardottir O, Bjornsson ES. Risk factors for Clostridium difficile toxin-positive diarrhea: a population-based prospective case–control study. Eur J Clin Microbiol Infect Dis. 2012;31:2601–10.

    Article  CAS  PubMed  Google Scholar 

  46. Bender B, Laughon B, Gaydos C, Forman M, Bennett R, Greenough III WB, et al. Is Clostridium difficile endemic in chronic care facilities? Lancet. 1986;328:11–3.

    Article  Google Scholar 

  47. Simor AE, Yake SL, Tsimidis K. Infection due to Clostridium difficile among elderly residents of a long-term-care facility. Clin Infect Dis. 1993;17:672–8.

    Article  CAS  PubMed  Google Scholar 

  48. Arvand M, Moser V, Schwehn C, Bettge-Weller G, Hensgens MP, Kuijper EJ. High prevalence of Clostridium difficile colonization among nursing home residents in Hesse, Germany. PLoS ONE. 2012;7:e30183.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  49. Marciniak C, Chen D, Stein AC, Semik PE. Prevalence of Clostridium difficile colonization at admission to rehabilitation. Arch Phys Med Rehabil. 2006;87:1086–90.

    Article  PubMed  Google Scholar 

  50. Riggs MM, Sethi AK, Zabarsky TF, Eckstein EC, Jump RLP, Donskey CJ. Asymptomatic carriers are a potential source for transmission of epidemic and nonepidemic Clostridium difficile strains among long-term care facility residents. Clin Infect Dis. 2007;45:992–8.

    Article  PubMed  Google Scholar 

  51. Bartlett JG. Antibiotic-associated diarrhea. N Engl J Med. 2002;346:334–9.

    Article  PubMed  Google Scholar 

  52. Rea MC, O’Sullivan O, Shanahan F, O’Toole PW, Stanton C, Ross RP, Hill C. 2011. Clostridium difficile Carriage in Elderly Subjects and Associated Changes in the Intestinal Microbiota. J. Clin. Microbiol. 2012;50(3):867–75.

  53. Guerrero DM, Becker JC, Eckstein EC, Kundrapu S, Deshpande A, Sethi AK, et al. Asymptomatic carriage of toxigenic Clostridium difficile by hospitalized patients. J Hosp Infect. 2013;85:155–8.

    Article  CAS  PubMed  Google Scholar 

  54. Jones AL, Dwyer LL, Bercovitz AR, Strahan GW. The National nursing home survey: 2004 overview. Vital Health Stat. 2009;13:1–155.

    CAS  Google Scholar 

  55. Kim JH, Toy D, Muder RR. Clostridium difficile infection in a long-term care facility: hospital-associated illness compared with long-term care–associated illness. Infect Control Hosp Epidemiol. 2011;32:656–60.

    Article  PubMed  Google Scholar 

  56. Pawar DMD, Tsay R, MPH MLS, Nelson DSMSN, Elumalai MKMS, Lessa FCMD, et al. Burden of Clostridium difficile infection in long-term care facilities in Monroe County. N Y Infect Control Hosp Epidemiol. 2012;33:1107–12.

    Article  Google Scholar 

  57. Barrett SP, Holmes AH, Newsholme WA, Richards M. Increased detection of Clostridium difficile during a norovirus outbreak. J Hosp Infect. 2007;66:394–5.

    Article  CAS  PubMed  Google Scholar 

  58. Wilcox M, Fawley W. Viral gastroenteritis increases the reports of Clostridium difficile infection. J Hosp Infect. 2007;66:395–6.

    Article  CAS  PubMed  Google Scholar 

  59. Koo HL, Ajami NJ, Jiang Z-D, DuPont HL, Atmar RL, Lewis D, et al. A nosocomial outbreak of norovirus infection masquerading as Clostridium difficile infection. Clin Infect Dis. 2009;48:e75–7.

    Article  PubMed Central  PubMed  Google Scholar 

  60. Scheurer D. Diagnostic and treatment delays in recurrent Clostridium difficile-associated disease. J Hosp Med Off Publ Soc Hosp Med. 2008;3:156–9.

    Article  Google Scholar 

  61. Kundrapu S, Jury LA, Sitzlar B, Sunkesula VCK, Sethi AK, Donskey CJ. Easily modified factors contribute to delays in diagnosis of Clostridium difficile infection: a cohort study and intervention. J Clin Microbiol. 2013;51:2365–70.

    Article  PubMed Central  PubMed  Google Scholar 

  62. Vardakas KZ, Polyzos KA, Patouni K, Rafailidis PI, Samonis G, Falagas ME. Treatment failure and recurrence of Clostridium difficile infection following treatment with vancomycin or metronidazole: a systematic review of the evidence. Int J Antimicrob Agents. 2012;40:1–8.

    Article  CAS  PubMed  Google Scholar 

  63. McFarland LV, Surawicz CM, Rubin M, Fekety R, Elmer GW, Greenberg RN. Recurrent Clostridium difficile disease: epidemiology and clinical characteristics. Infect Control Hosp Epidemiol Off J Soc Hosp Epidemiol Am. 1999;20:43–50.

    Article  CAS  Google Scholar 

  64. Fekety R, McFarland LV, Surawicz CM, Greenberg RN, Elmer GW, Mulligan ME. Recurrent Clostridium difficile diarrhea: characteristics of and risk factors for patients enrolled in a prospective, randomized, double-blinded trial. Clin Infect Dis. 1997;24:324–33.

    Article  CAS  PubMed  Google Scholar 

  65. D’Agostino RB, Collins SH, Pencina KM, Kean Y, Gorbach S. Risk estimation for recurrent Clostridium difficile infection based on clinical factors. Clin Infect Dis. 2014;58:1386–93.

    Article  PubMed  Google Scholar 

  66. Johnson S, Adelmann A, Clabots CR, Peterson LR, Gerding DN. Recurrences of Clostridium difficile diarrhea not caused by the original infecting organism. J Infect Dis. 1989;159:340–3.

    Article  CAS  PubMed  Google Scholar 

  67. Barbut F, Richard A, Hamadi K, Chomette V, Burghoffer B, Petit J-C. Epidemiology of recurrences or reinfections of Clostridium difficile-associated diarrhea. J Clin Microbiol. 2000;38:2386–8.

    CAS  PubMed Central  PubMed  Google Scholar 

  68. Abujamel T, Cadnum JL, Jury LA, Sunkesula VCK, Kundrapu S, Jump RL, et al. Defining the vulnerable period for re-establishment of clostridium difficile colonization after treatment of C. difficile infection with oral vancomycin or metronidazole. PLoS ONE. 2013;8:e76269.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  69. Louie TJ, Miller MA, Mullane KM, Weiss K, Lentnek A, Golan Y, et al. Fidaxomicin versus vancomycin for Clostridium difficile infection. N Engl J Med. 2011;364:422–31.

    Article  CAS  PubMed  Google Scholar 

  70. Cornely OA, Miller MA, Louie TJ, Crook DW, Gorbach SL. Treatment of first recurrence of Clostridium difficile infection: fidaxomicin versus vancomycin. Clin Infect Dis. 2012;55:S154–61.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  71. Tannock GW, Munro K, Taylor C, Lawley B, Young W, Byrne B, et al. A new macrocyclic antibiotic, fidaxomicin (OPT-80), causes less alteration to the bowel microbiota of Clostridium difficile-infected patients than does vancomycin. Microbiology. 2010;156:3354–9.

    Article  CAS  PubMed  Google Scholar 

  72. Bartsch SM, Umscheid CA, Fishman N, Lee BY. 2013. Is Fidaxomicin worth the cost? An economic analysis. Clin. Infect. Dis. 2013;57(4):555–61.

  73. Stranges PM, Hutton DW, Collins CD. Cost-effectiveness analysis evaluating fidaxomicin versus oral vancomycin for the treatment of Clostridium difficile infection in the United States. Value Health J Int Soc Pharmacoeconomics Outcomes Res. 2013;16:297–304.

    Article  Google Scholar 

  74. Bowden TA, Mansberger AR, Lykins LE. Pseudomembraneous enterocolitis: mechanism for restoring floral homeostasis. Am Surg. 1981;47:178–83.

    PubMed  Google Scholar 

  75. Tvede M, Rask-Madsen J. Bacteriotherapy for chronic relapsing Clostridium difficile diarrhoea in six patients. Lancet. 1989;1:1156–60.

    Article  CAS  PubMed  Google Scholar 

  76. Van Nood E, Vrieze A, Nieuwdorp M, Fuentes S, Zoetendal EG, de Vos WM, et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. N Engl J Med. 2013;368:407–15. The authors described a randomized, controlled trial demonstrating the benefit of fecal transplant to successfully treat recurrent C. difficile infection. The clinical trial uses donor feces from prescreened donors.

    Article  PubMed  Google Scholar 

  77. MacConnachie AA, Fox R, Kennedy DR, Seaton RA. Faecal transplant for recurrent Clostridium difficile-associated diarrhoea: a UK case series. QJM Mon J Assoc Phys. 2009;102:781–4.

    CAS  Google Scholar 

  78. Brandt LJ, Aroniadis OC, Mellow M, Kanatzar A, Kelly C, Park T, et al. Long-term follow-up of colonoscopic fecal microbiota transplant for recurrent Clostridium difficile infection. Am J Gastroenterol. 2012;107:1079–87.

    Article  PubMed  Google Scholar 

  79. Rubin TA, Gessert CE, Aas J. Stool transplantation for older patients with Clostridium difficile infection. J Am Geriatr Soc. 2009;57:2386.

    Article  PubMed  Google Scholar 

  80. Konijeti GG, Sauk J, Shrime MG, Gupta M, Ananthakrishnan AN. Cost-effectiveness of competing strategies for management of recurrent Clostridium difficile infection: a decision analysis. Clin Infect Dis. 2014;58:1507–14.

    Article  PubMed  Google Scholar 

  81. Benoit SR, Nsa W, Richards CL, Bratzler DW, Shefer AM, Steele LM, et al. Factors associated with antimicrobial use in nursing homes: a multilevel model. J Am Geriatr Soc. 2008;56:2039–44.

    Article  PubMed  Google Scholar 

  82. Nicolle LE, Bentley DW, Garibaldi R, Neuhaus EG, Smith PW. Antimicrobial use in long‐term–care facilities. Infect Control Hosp Epidemiol. 2000;21:537–45.

    Article  CAS  PubMed  Google Scholar 

  83. Peron EP, Hirsch AA, Jury LA, Jump RLP, Donskey CJ. Another setting for stewardship: high rate of unnecessary antimicrobial use in a veterans affairs long-term care facility. J Am Geriatr Soc. 2013;61:289–90.

    Article  PubMed  Google Scholar 

  84. Rotjanapan P, Dosa D, Thomas KS. Potentially inappropriate treatment of urinary tract infections in two rhode island nursing homes. Arch Intern Med. 2011;171:438–43.

    Article  PubMed  Google Scholar 

  85. Nathwani D, Sneddon J, Malcolm W, Wiuff C, Patton A, Hurding S, et al. Scottish Antimicrobial Prescribing Group (SAPG): development and impact of the Scottish National Antimicrobial Stewardship Programme. Int J Antimicrob Agents. 2011;38:16–26.

    Article  CAS  PubMed  Google Scholar 

  86. Jump RLP, Olds DM, Seifi N, Kypriotakis G, Jury LA, Peron EP, et al. Effective antimicrobial stewardship in a long-term care facility through an infectious disease consultation service: keeping a LID on antibiotic use. Infect Control Hosp Epidemiol Off J Soc Hosp Epidemiol Am. 2012;33:1185–92.

    Article  Google Scholar 

  87. Jump RLP, Olds DM, Jury LA, Sitzlar B, Saade E, Watts B, Bonomo RA, Donskey CJ. 2013. Specialty care delivery: bringing infectious disease expertise to the residents of a veterans affairs long-term care facility. J Am Geriatr Soc. 2013;61(5):782–7.

  88. Nicolle LE. Antimicrobial stewardship in long-term care facilities: what is effective? Antimicrob Resist Infect Control. 2014;3:6.

    Article  PubMed Central  PubMed  Google Scholar 

  89. Jinno S, Kundrapu S, Guerrero DM, Jury LA, Nerandzic MM, Donskey CJ. Potential for transmission of Clostridium difficile by asymptomatic acute care patients and long-term care facility residents with prior C. difficile infection. Infect Control Hosp Epidemiol Off J Soc Hosp Epidemiol Am. 2012;33:638–9.

    Article  Google Scholar 

  90. Kyne L, Warny M, Qamar A, Kelly CP. Asymptomatic carriage of Clostridium difficile and serum levels of IgG antibody against toxin A. N Engl J Med. 2000;342:390–7.

    Article  CAS  PubMed  Google Scholar 

  91. Kyne L, Warny M, Qamar A, Kelly CP. Association between antibody response to toxin A and protection against recurrent Clostridium difficile diarrhoea. Lancet. 2001;357:189–93.

    Article  CAS  PubMed  Google Scholar 

  92. McDonald LC, Coignard B, Dubberke E, Song X, Horan T, Kutty PK. Recommendations for surveillance of Clostridium difficile-associated disease. Infect Control Hosp Epidemiol Off J Soc Hosp Epidemiol Am. 2007;28:140–5.

    Article  Google Scholar 

  93. Zabarsky TF, Sethi AK, Donskey CJ. Sustained reduction in inappropriate treatment of asymptomatic bacteriuria in a long-term care facility through an educational intervention. Am J Infect Control. 2008;36:476–80.

    Article  PubMed  Google Scholar 

  94. Sitzlar B, Deshpande A, Fertelli D, Kundrapu S, Sethi AK, Donskey CJ. An environmental disinfection odyssey: evaluation of sequential interventions to improve disinfection of Clostridium difficile isolation rooms. Infect Control Hosp Epidemiol Off J Soc Hosp Epidemiol Am. 2013;34:459–65.

    Article  Google Scholar 

  95. Sitzlar B, Jury LA, Kundrapu S, Cadnum JL, Donskey CJ. Effectiveness of an ultraviolet radiation device for disinfection of personal use items in rooms of long-term care facility residents. Society for Healthcare Epidemiology of America. Texas: Dallas; 2011.

    Google Scholar 

  96. Sitzlar B, Vajravelu RK, Jury L, Donskey CJ, Jump RLP. Environmental decontamination with ultraviolet radiation to prevent recurrent Clostridium difficile infection in 2 roommates in a long-term care facility. Infect Control Hosp Epidemiol Off J Soc Hosp Epidemiol Am. 2012;33:534–6.

    Article  Google Scholar 

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Acknowledgments

RLPJ gratefully acknowledges the T. Franklin Williams Scholarship with funding provided by Atlantic Philanthropies, Inc., the John A. Hartford Foundation, the Association of Specialty Professors, the Infectious Diseases Society of America and the National Foundation for Infectious Diseases. This work was supported by the Veterans Integrated Service Network 10 Geriatric Research Education and Clinical Center (VISN 10 GRECC; RLPJ, CJD), the Veterans Affairs Merit Review Program (CJD) and the Clinical and Translational Science Collaborative of Cleveland, UL1TR000439 from the National Center for Advancing Translational Sciences (NCATS) component of the National Institutes of Health and NIH roadmap for Medical Research (RLPJ). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

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Conflict of Interest

Robin L.P. Jump has received payment (honoraria) for lectures given to the Ohio Medical Director’s Association, the National Association of Director of Nursing Administration (NADONA), and the North East Ohio Nurse Practitioner Conference; and has received research support from Pfizer, the Veterans Affairs T-21 Program (NILTC G541-3) and the National Institutes of Health (R03-AG040722).

Curtis J. Donskey has served on boards for 3M and Merck, has served as a consultant for Clorox and GOJO, and has received research support through grants from Cubist, AvidBiotics, Pfizer, GOJO, Clorox, and Ecolab.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Geriatric Research Education and Clinical Center, 111O(W), Cleveland Veterans Affairs Medical Center, 10701 East Boulevard, Cleveland, OH, 44106, USA

    Robin L. P. Jump & Curtis J. Donskey

  2. Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University, Cleveland, OH, USA

    Robin L. P. Jump & Curtis J. Donskey

  3. Research Service, Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA

    Curtis J. Donskey

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  1. Robin L. P. Jump
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  2. Curtis J. Donskey
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Correspondence to Robin L. P. Jump.

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This article is part of the Topical Collection on Infectious Diseases in the Elderly

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Jump, R.L.P., Donskey, C.J. Clostridium difficile in the Long-Term Care Facility: Prevention and Management. Curr Geri Rep 4, 60–69 (2015). https://doi.org/10.1007/s13670-014-0108-3

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  • DOI: https://doi.org/10.1007/s13670-014-0108-3

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