title: The acquisition and outcome of ICU-acquired Clostridium difficile infection in a single centre in the UK.
abstract: BACKGROUND
  The clinical course and outcome of Clostridium difficile infection (CDI) in the intensive care unit (ICU) setting have been reported in a small number of studies in the US and Canada. However, no such study has been reported in the UK. Therefore, we aimed to study the acquisition rate and outcome of ICU-acquired CDIs in our unit.
  
  
  METHODS
  Patient admissions to the ICU and nosocomial infection databases from April 2004 to April 2007 were reviewed to identify study groups, followed by retrospective case note review. Patients who acquired CDI prior to ICU admission were excluded.
  
  
  RESULTS
  Sixty-two patients (31 males) who acquired CDI during their ICU stays were included in our study. The acquisition rate of CDI ranged from 1.52 to 4.78% per year. The median APACHE II score was 18, and the median interval between ICU admission and acquisition of CDI was 7 days. The median ICU stay was 16 days. Of the 62 patients, 13 (20.97%) died in the ICU. Of the 49 patients who were discharged, 41 were discharged ultimately from the hospital. Thus, the overall mortality attributable to CDI acquired in the ICU was 33.87%, compared to the average baseline mortality of 29% in our unit. Univariate analysis showed that increasing age (p = 0.004), APACHE II score (p=0.007), and male gender (p = 0.05) were significantly associated with ICU mortality in patients who acquired CDI in the ICU. Multivariate analysis showed that only increasing age (p = 0.031; OR 1.141, CI 1.013-1.287) was significantly associated with higher ICU mortality.
  
  
  CONCLUSIONS
  Patients admitted to the ICU have a moderate risk of acquiring CDI. There is a small increase in mortality observed in patients who acquired CDI in the ICU. Increasing age is an independent predictor associated with mortality.
authors.affiliation: Intensive Care Unit, North Staffordshire University Hospital, Newcastle Road, Stoke-On-Trent, ST4 6QG, UK. acwee@doctors.org.uk
authors.forename: Chin Wee
authors.initials: CW
authors.lastname: Ang
authors.forename: Graham
authors.initials: G
authors.lastname: Heyes
authors.forename: Paul
authors.initials: P
authors.lastname: Morrison
authors.forename: Bryan
authors.initials: B
authors.lastname: Carr
mesh_terms: D018806:APACHE; D000367:Age Factors; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003428:Cross Infection / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology