High Prevalence and Frequent Acquisition of Clostridium difficile Ribotype 002 Among Nursing Home Residents in Hong Kong

Abstract

OBJECTIVETo determine the incidence and risk factors associated withClostridium difficilecolonization among residents of nursing homes and to identify the ribotypes of circulatingC. difficilestrains.DESIGNA prospective cohort study with a follow-up duration of 22 months.SETTINGNursing homes.PARTICIPANTSOf the 375 residents in 8 nursing homes, 300 residents (80.0%) participated in the study. A further prospective study of 4 nursing homes involving 141 residents with a minimum of 90 days of follow-up was also performed.METHODSBaseline and 90-day stool cultures were obtained; additional stool cultures were obtained for residents who had been discharged from hospitals. Polymerase chain reaction (PCR) ribotyping andslpAtyping were performed for allC. difficilestrains isolated.RESULTSToxigenicC. difficilewas isolated in 30 residents (10%) at baseline, and 9 residents (7.3%) had acquired toxigenicC. difficilein the nursing homes. The presence of nasogastric tube was an independent risk factor (adjusted odds ratio, 8.59; 95% confidence interval, 1.18–62.53;P=.034) forC. difficilecolonization. The Kaplan-Meier estimate of median carriage duration was 13 weeks. TheC. difficileribotypes most commonly identified were 002 (40.8%), 014 (16.9%), 029 (9.9%), and 053 (8.5%).CONCLUSIONSThe high incidence ofC. difficilecolonization and the overrepresentation ofC. difficileribotype 002 confirmed the contribution of nursing home residents toC. difficiletransmission across the continuum of care. An infection control program is needed in long-term care.Infect Control Hosp Epidemiol2018;782–787