Researchers conducted a case-cohort study of individuals who spent at least three days in one of 131 acute care or 120 long-term care facilities managed by the Veterans Health Administration between 2006 and 2012. The researchers defined the outcome as the incidence of facility-onset laboratory-identified C. diff, that is, a person with a positive C. diff test who did not have a positive test in the previous two months.
The C. diff infection incidence in the acute care setting was five times the incidence observed in the long-term care setting — 15.6 versus 3.2 per 10,000 person-days.
The study also shows that antibiotic use was higher in the acute care setting compared to long-term care setting, and this explained 72 percent of the variation in C. diff rates.
The researchers also investigated acute care patients with recent long-term care attributable C. diff infection and long-term care residents with recent acute care attributable C. diff infection. The importation of C. diff cases was three times higher among long-term care patients as compared to acute care patients.
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