Hospital-acquired Clostridium difficile-associated disease in the intensive care unit setting: epidemiology, clinical course and outcome.
BACKGROUND
Clostridium difficile-associated disease (CDAD) is a serious nosocomial infection, however few studies have assessed CDAD outcome in the intensive care unit (ICU). We evaluated the epidemiology, clinical course and outcome of hospital-acquired CDAD in the critical care setting.


METHODS
We performed a historical cohort study on 58 adults with a positive C. difficile cytotoxin assay result occurring in intensive care units.


RESULTS
Sixty-two percent of patients had concurrent infections, 50% of which were bloodstream infections. The most frequently prescribed antimicrobials prior to CDAD were anti-anaerobic agents (60.3%). Septic shock occurred in 32.8% of CDAD patients. The in-hospital mortality was 27.6%. Univariate analysis revealed that SOFA score, at least one organ failure and age were predictors of mortality. Charlson score >/=3, gender, concurrent infection, and number of days with diarrhea before a positive C. difficile toxin assay were not significant predictors of mortality on univariate analysis. Independent predictors for death were SOFA score at infection onset (per 1-point increment, OR 1.40; CI95 1.13-1.75) and age (per 1-year increment, OR 1.10; CI95 1.02-1.19).


CONCLUSIONS
In ICU patients with CDAD, advanced age and increased severity of illness at the onset of infection, as measured by the SOFA score, are independent predictors of death.
Marra
Alexandre R
AR
Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil. a.marra@uol.com.br
Edmond
Michael B
MB
Wenzel
Richard P
RP
Bearman
Gonzalo M L
GM
D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use; D002648:Child; D016360:Clostridioides difficile / Q000302:isolation & purification*; D015331:Cohort Studies; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D004761:Enterocolitis, Pseudomembranous / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D008795:Metronidazole