Teena Chopra - Clostridium Difficile Infection in Long-Term Care Facilities: A Clinicians Guide

Clostridium (Clostridioides) difficile is a spore-forming, anaerobic, gram-positive bacillus. It accounts for 1020% of episodes of antibiotic-associated diarrhea and majority of cases of antibiotic-associated colitis [].

CDI is 510 times more common in older adults compared to younger adults []. There is considerable overlap between the two terms (LTCF and nursing home) and the terms are frequently used interchangeably.

In the United States (US), there are approximately 15,600 nursing homes providing care to >3 million people each year, and on any given day, close to 1.4 million people reside in the nations nursing homes [].

It is estimated that about 100,000110,000 cases of CDI occur in LTCF residents annually in the United States. This number comprises about one-third of healthcare-associated CDI [].

Many factors are likely responsible for increased risk of CDI in older adults residing in LTCFs. Some of these factors include frequent hospitalizations, increased exposure to antibiotics, and presence of comorbidities [].

Due to the continued threat of C. difficile to LTCF residents, more needs to be done to address the problem. Surveys in LTCF setting has shown that recommended C. difficile related infection control and environmental cleaning practices are inconsistently followed []. Such is the nature of the CDI problem in LTCFs that successful control will require involvement of multiple disciplines including facility leadership/administrators, physicians, pharmacists, laboratory, and nurses. Collaboration with regional acute care hospitals is also needed to obtain the resources and expertise for LTCF CDI surveillance, antibiotic stewardship, and infection control programs.

Various regulations, guidance, and support have come from national, state, and regional institutions in the United States to curb the CDI problem in LTCFs. The Centers for Medicare & Medicaid Services (CMS) mandated the establishment of antibiotic stewardship programs in LTCFs by November 2017 [].

Although several resources are available to address the CDI problem in LTCFs, there is lack of a comprehensive resource that addresses all aspects of CDI in the LTCF setting. This book aims to fill this gap and will provide comprehensive information on all aspects of CDI pertaining to the LTCF setting including epidemiology, risk factors, diagnosis, prevention and treatment. This book will also feature a chapter on LTCF CDI surveillance and role of asymptomatic carriers on CDI transmission and discuss the role of probiotics for CDI prevention and update on new recommendations regarding CDI diagnosis, treatment, and infection control. This book will serve as a valuable resource to physicians, LTCF leadership/administrators, LTCF nurses, infection control personnel working in LTCFs, and LTCF pharmacists. In addition, this book will serve as a useful guide to anyone who is keen to conduct research on CDI in the LTCF setting.