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Background Advanced age, history of hospitalization, and antibiotic consumption are associated with the pathogenesis of Clostridium difficile infection ( CDI). Long-term care facilities ( LTCFs) represent a setting where CDI has been increasingly reported. We aimed to estimate the actual attributable burden of CDI to LTCF stay and determine the characteristics of the disease epidemiology in this setting. Design IRB-approved retrospective cohort study. Setting LTCF and community. Participants One thousand seven hundred and sixty-one patients. Measurements/Results The prevalence of CDI among LTCF residents was 22.4%, whereas the prevalence of CDI among community residents was 6.7% ( P < .001). The prevalence of CDI among LTCF residents was significantly higher in both the 18-64 ( P < .001) and the ≥65 age groups ( P < .010). Measures of hospital exposure and antibiotic consumption between LTCF and community residents prior to CDI diagnosis were non-significant. A strict matching (1:2) between LTCF and community residents adjusting for age, total number of hospital admissions and antibiotic consumption showed that the odds of CDI for an LTCF resident were 6.89 times larger than the odds for a community resident ( OR = 6.89, 95%, 4.67-10.17). For an LTCF resident with CDI, the odds of manifesting severe disease were 3.25 times larger than the odds for a community resident with CDI ( OR = 3.25, 95%, 1.81-5.86). LTCF residents were more frequently hospitalized ( P = .002) required longer hospital stays for their CDI management ( P = .03) and had more recurrent CDI cases than community residents ( P = .04). Conclusions Our study highlights the increased burden of CDI among LTCF residents independently of age, antibiotic, and hospitalization background. Severe CDI disease and recurrences are more frequent in LTCFs. [ABSTRACT FROM AUTHOR]

Use of cardiovascular implantable electronic devices ( CIED), including permanent pacemakers ( PPM) and implantable cardioverter defibrillators ( ICD), has increased dramatically over the past two decades. Most CIED infections are caused by staphylococci. Fungal causes are rare and their prognosis is poor. To our knowledge, there has not been a previously reported case of multifocal Candida endocarditis involving both a native left-sided heart valve and a CIED lead. Here, we report the case of a 70-year-old patient who presented with nausea, vomiting, and generalised fatigue, and was found to have Candida glabrata endocarditis involving both a native aortic valve and right atrial ICD lead. We review the literature and summarise four additional cases of CIED-associated Candida endocarditis published from 2009 to 2014, updating a previously published review of cases prior to 2009. We additionally review treatment guidelines and discuss management of CIED-associated Candida endocarditis. [ABSTRACT FROM AUTHOR]