Clostridium difficile infection in critically injured trauma patients.
BACKGROUND
Clostridium difficile infection (CDI) is an increasing problem worldwide. To our knowledge, there are no studies evaluating specifically the incidence of CDI in the critically injured trauma population.


METHODS
Five hundred eighty-one consecutive critically injured trauma patients were followed prospectively for development of CDI, diagnosed by toxin assay. Testing was ordered on the basis of symptoms. Antibiotic usage was classified as surgical prophylaxis or therapeutic.


RESULTS
Nineteen cases of CDI were diagnosed in 581 patients (3.3%). Age, sex, race, and injury severity score (ISS) were similar in patients with and without CDI (p > 0.2); the mean ISS in patients with CDI was 29 points. Intensive care unit length of stay (ICU LOS), ventilator days, and hospital length of stay (HLOS) were significantly higher in the CDI patients. The diagnosis was made a mean of 17 days after admission; however, in four patients (21%), the infections were diagnosed within six days of admission. Fourteen patients (74%) had received therapeutic antibiotics for confirmed or suspected infection prior to the appearance of colitis; four patients (21%) received only intraoperative prophylaxis, and one patient had no antibiotic exposure. These five patients were significantly younger than those who developed CDI after therapeutic antibiotic usage and had significantly shorter HLOS and ICU LOS (p < 0.05). This result persisted after controlling for age using multiple linear regression analysis.


CONCLUSIONS
Clostridium difficile infection occurred in 3.3% of patients and was diagnosed as early as the fourth hospital day. We have identified a unique subgroup of younger patients who developed CDI after minimal or no antibiotic exposure. Further study is needed to characterize this population.
Lumpkins
Kimberly
K
Division of Clinical & Outcomes Research, R. Adams Cowley Shock Trauma Center, Baltimore, Maryland.
Bochicchio
Grant V
GV
Joshi
Manjari
M
Gens
Ryan
R
Bochicchio
Kelly
K
Conway
Anne
A
Schaub
Stacey
S
Scalea
Thomas
T
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000302:isolation & purification*; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008396:Maryland; D008875:Middle Aged; D009104:Multiple Trauma; D014193:Trauma Centers / Q000706:statistics & numerical data*; D055815:Young Adult
D000900:Anti-Bacterial Agents