{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T10:45:23Z","timestamp":1791283523432,"version":"4.1.0"},"reference-count":37,"publisher":"Cambridge University Press (CUP)","issue":"8","license":[{"start":{"date-parts":[[2018,5,31]],"date-time":"2018-05-31T00:00:00Z","timestamp":1527724800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2018,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0899823X1800106X_abs1\" sec-type=\"general\"><jats:title>Objective<\/jats:title><jats:p>To test the hypothesis that long-term care facility (LTCF) residents with<jats:italic>Clostridium difficile<\/jats:italic>infection (CDI) or asymptomatic carriage of toxigenic strains are an important source of transmission in the LTCF and in the hospital during acute-care admissions.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X1800106X_abs2\" sec-type=\"general\"><jats:title>Design<\/jats:title><jats:p>A 6-month cohort study with identification of transmission events was conducted based on tracking of patient movement combined with restriction endonuclease analysis (REA) and whole-genome sequencing (WGS).<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X1800106X_abs3\" sec-type=\"general\"><jats:title>Setting<\/jats:title><jats:p>Veterans Affairs hospital and affiliated LTCF.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X1800106X_abs4\" sec-type=\"general\"><jats:title>Participants<\/jats:title><jats:p>The study included 29 LTCF residents identified as asymptomatic carriers of toxigenic<jats:italic>C. difficile<\/jats:italic>based on every other week perirectal screening and 37 healthcare facility-associated CDI cases (ie, diagnosis &gt;3 days after admission or within 4 weeks of discharge to the community), including 26 hospital-associated and 11 LTCF-associated cases.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X1800106X_abs5\" sec-type=\"results\"><jats:title>Results<\/jats:title><jats:p>Of the 37 CDI cases, 7 (18\u00b79%) were linked to LTCF residents with LTCF-associated CDI or asymptomatic carriage, including 3 of 26 hospital-associated CDI cases (11\u00b75%) and 4 of 11 LTCF-associated cases (36\u00b74%). Of the 7 transmissions linked to LTCF residents, 5 (71\u00b74%) were linked to asymptomatic carriers versus 2 (28\u00b76%) to CDI cases, and all involved transmission of epidemic BI\/NAP1\/027 strains. No incident hospital-associated CDI cases were linked to other hospital-associated CDI cases.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X1800106X_abs6\" sec-type=\"conclusions\"><jats:title>Conclusions<\/jats:title><jats:p>Our findings suggest that LTCF residents with asymptomatic carriage of<jats:italic>C. difficile<\/jats:italic>or CDI contribute to transmission both in the LTCF and in the affiliated hospital during acute-care admissions. Greater emphasis on infection control measures and antimicrobial stewardship in LTCFs is needed, and these efforts should focus on LTCF residents during hospital admissions.<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2018.106","type":"journal-article","created":{"date-parts":[[2018,5,31]],"date-time":"2018-05-31T06:02:26Z","timestamp":1527746546000},"page":"909-916","source":"Crossref","is-referenced-by-count":52,"title":["Transmission of<i>Clostridium difficile<\/i>from asymptomatically colonized or infected long-term care facility residents"],"prefix":"10.1017","volume":"39","author":[{"given":"Curtis J.","family":"Donskey","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venkata C. 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