title: Hospital-acquired Clostridium difficile-associated disease in the intensive care unit setting: epidemiology, clinical course and outcome.
abstract: 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.
authors.affiliation: Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil. a.marra@uol.com.br
authors.forename: Alexandre R
authors.initials: AR
authors.lastname: Marra
authors.forename: Michael B
authors.initials: MB
authors.lastname: Edmond
authors.forename: Richard P
authors.initials: RP
authors.lastname: Wenzel
authors.forename: Gonzalo M L
authors.initials: GM
authors.lastname: Bearman
mesh_terms: 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
chemical_list: D000890:Anti-Infective Agents; D008795:Metronidazole