title: Analysis of 30-day mortality for clostridium difficile-associated disease in the ICU setting.
abstract: OBJECTIVE
  To examine the 30-day mortality rate among patients with Clostridium difficile-associated disease (CDAD) requiring intensive care.
  
  
  METHODS
  A retrospective, single-center, observational, cohort study.
  
  
  METHODS
  Barnes-Jewish Hospital, a 1,200-bed, urban, teaching facility.
  
  
  METHODS
  Adult patients admitted to the ICU identified to have CDAD by enzyme immunoassay.
  
  
  METHODS
  Retrospective data collection from automated hospital, microbiology, and pharmacy databases.
  
  
  RESULTS
  Two hundred seventy-eight patients with CDAD admitted to an ICU were identified over a 2-year period. Two hundred six patients (74.1%) received prior antibiotic therapy. The overall 30-day mortality rate was 36.7% (n = 102). Logistic regression analysis identified septic shock (adjusted odds ratio, 1.96; 95% confidence interval [CI], 1.47 to 2.61; p = 0.018), ward-to-ICU transfer (adjusted odds ratio, 2.12; 95% CI, 1.62 to 2.79; p = 0.006), and increasing APACHE (acute physiology and chronic health evaluation) II scores (1-point increments) [adjusted odds ratio, 1.09; 95% CI, 1.07 to 1.12; p < 0.001] as independent predictors for 30-day mortality. The attributable mortality associated with CDAD was estimated to be 6.1% (95% CI, - 1.7 to 13.9%; p = 0.127). CDAD was associated with an excess ICU length of stay (2.2 days) and hospital length of stay (4.5 days).
  
  
  CONCLUSIONS
  We found a high 30-day crude mortality among patients with CDAD in the ICU setting. Although the attributable mortality from CDAD was relatively low, excess length of stay in the ICU and hospital was observed with CDAD. ICUs should routinely employ infection control efforts aimed at minimizing the occurrence of CDAD because of the excess morbidity associated with this nosocomial infection.
authors.affiliation: Washington University School of Medicine, 660 South Euclid Ave, Campus Box 8052, St. Louis, MO 63110, USA.
authors.forename: Claire
authors.initials: C
authors.lastname: Kenneally
authors.forename: Jamie M
authors.initials: JM
authors.lastname: Rosini
authors.forename: Lee P
authors.initials: LP
authors.lastname: Skrupky
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Doherty
authors.forename: James M
authors.initials: JM
authors.lastname: Hollands
authors.forename: Emily
authors.initials: E
authors.lastname: Martinez
authors.forename: Wendi E
authors.initials: WE
authors.lastname: McKinzie
authors.forename: Wendi
authors.initials: W
authors.lastname: McKenzie
authors.forename: Theresa
authors.initials: T
authors.lastname: Murphy
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Smith
authors.forename: Scott T
authors.initials: ST
authors.lastname: Micek
authors.forename: Marin H
authors.initials: MH
authors.lastname: Kollef
mesh_terms: D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016360:Clostridioides difficile / Q000302:isolation & purification*; D016001:Confidence Intervals; D004761:Enterocolitis, Pseudomembranous / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D016017:Odds Ratio; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000382:microbiology / Q000401:mortality; D016019:Survival Analysis; D015996:Survival Rate / Q000639:trends