Epidemiology of Clostridioides Difficile Infection (CDI) in Long-term Care Facilities, Assessment of Professional Practices Related to CDI Risk Prevention, and Strategies for Improving Care. (EpiCE)

Clostridioides difficile infection (CDI) is the leading cause of infectious diarrhea among older adults. The epidemiology of community-acquired CDI, particularly among residents of long-term care facilities, remains poorly understood to this day. While numerous studies on the epidemiology, prevention, diagnosis, and treatment of CDI have been conducted in hospital settings, primary care often lags behind these advances. Limited access to diagnostic tests and treatment options, as well as insufficient resources allocated to preventing cross-transmission, are all factors that hinder the control of ICD in long-term care facilities. This will be the first French study on the epidemiology of ICD among nursing home residents, which can serve as a reference for implementing a multidisciplinary action plan and measuring its impact. This will be carried out as part of a city-hospital collaboration and will facilitate the creation of a healthcare network involving multiple healthcare providers, such as general practitioners working in nursing homes, clinical laboratories, pharmacies, dietitians and nutritionists, and the university hospital.

A better understanding of the epidemiology of ICD among residents in long-term care facilities and an assessment of professional practices related to ICD risk prevention should enable us to better target strategies for improving care while raising awareness among healthcare providers and public health policymakers. We therefore plan to optimize the impact of implementing a multidisciplinary action program aligned with the expectations of frontline practitioners regarding the reduction of the risk of ICD (training, prevention tools, diagnosis and treatment of ICD, appropriate use of antibiotics, nutritional counseling, prescribing probiotics, and establishing a coordinated care pathway for ICD). The implementation of this action program is expected to reduce the incidence rate of ICD, the recurrence rate, and antibiotic use in nursing homes, as well as the number of transfers to the hospital for ICD management.