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Author Notes:

Correspondence: J. Hunter, 1600 Clifton Road, MS A-24, Atlanta, GA 30333 (jhunter@cdc. gov).

We acknowledge the following contributors: Erin Garcia, Erin Parker, Joelle Nadle, and Gretchen Rothrock (California Emerging Infections Program); Carol Lyons (Connecticut Emerging Infections Program); Wendy Bamberg (Colorado Emerging Infections Program); Olivia Almendares, Wendy Baughman, Leigh Ann Clark, Andrew Revis, and Zirka Smith (Georgia Emerging Infections Program); Lucy Wilson (Maryland Emerging Infections Program); Ruth Lynfield (Minnesota Emerging Infections Program); Nicole Kenslow (New Mexico Emerging Infections Program); Rebecca Tsay and Deborah Nelson (New York Emerging Infections Program); Valerie Ocampo (Oregon Emerging Infections Program); Samir Hanna, Amanda Ingram, Brenda Rue, and Corrine Davis (Tennessee Emerging Infections Program); Susan Sambol and Laurica Petrella (Hines VA Hospital); Brandi Limbago, James K. Rasheed, and Ashley Paulick (Centers for Disease Control and Prevention).

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Potential conflicts of interest: Dr Gerding is a board member of Merck, Rebiotix, Summit, and Actelion, and consults for Sanofi Pasteur, DaVolterra, Pfizer, and Cubist, all of which perform research on potential C difficile products. D. N. G. is a consultant for and has patents licensed to Shire. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.


Research Funding:

This work was funded by the Emerging Infections Program Cooperative Agreement between the 10 EIP sites and the Centers for Disease Control and Prevention.


  • Clostridium difficile
  • long-term care facility
  • nursing home

Burden of Nursing Home-Onset Clostridium difficile Infection in the United States: Estimates of Incidence and Patient Outcomes.

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Journal Title:

Open Forum Infectious Diseases


Volume 3, Number 1


, Pages ofv196-ofv196

Type of Work:

Article | Final Publisher PDF


Background.  Approximately 4 million Americans receive nursing home (NH) care annually. Nursing home residents commonly have risk factors for Clostridium difficile infection (CDI), including advanced age and antibiotic exposures. We estimated national incidence of NH-onset (NHO) CDI and patient outcomes. Methods.  We identified NHO-CDI cases from population-based surveillance of 10 geographic areas in the United States. Cases were defined by C difficile-positive stool collected in an NH (or from NH residents in outpatient settings or ≤3 days after hospital admission) without a positive stool in the prior 8 weeks. Medical records were reviewed on a sample of cases. Incidence was estimated using regression models accounting for age and laboratory testing method; sampling weights were applied to estimate hospitalizations, recurrences, and deaths. Results.  A total of 3503 NHO-CDI cases were identified. Among 262 sampled cases, median age was 82 years, 76% received antibiotics in the 12 weeks prior to the C difficile-positive specimen, and 57% were discharged from a hospital in the month before specimen collection. After adjusting for age and testing method, the 2012 national estimate for NHO-CDI incidence was 112 800 cases (95% confidence interval [CI], 93 400-131 800); 31 400 (28%) were hospitalized within 7 days after a positive specimen (95% CI, 25 500-37 300), 20 900 (19%) recurred within 14-60 days (95% CI, 14 600-27 100), and 8700 (8%) died within 30 days (95% CI, 6600-10 700). Conclusions.  Nursing home onset CDI is associated with substantial morbidity and mortality. Strategies focused on infection prevention in NHs and appropriate antibiotic use in both NHs and acute care settings may decrease the burden of NHO CDI.

Copyright information:

Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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