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Clinical risk factors for Clostridium difficile infection (CDI) have been studied extensively and are well validated. However, healthcare facilities have variable CDI rates that aren't entirely explained by patient-level factors. Thus, institutional risks as well as individual patient risks must be considered. In this retrospective nested case-control study, researchers examined CDI incidence among residents of Veterans Affairs (VA) long-term care facilities between 2006 and 2012.
A total of 6012 CDI cases were diagnosed in 5499 residents of facilities in 86 different “care regions” in the VA system. Most regions hosted a single long-term care facility, although a few had two or more. CDI incidence across regions varied by more than 48-fold.…