Clostridium difficile-associated disease acquired in the neurocritical care unit.
BACKGROUND
Clostridium difficile is an important cause of nosocomial infection on the intensive care unit. Little is known about infection rates on the neurocritical care unit (NICU). The purpose of this study was to determine the prevalence, severity, and outcome associated with Clostridium difficile-associated disease (CDAD) acquired on the NICU.


METHODS
Patients on NICU with a positive stool Clostridium difficile toxin assay, from August 2004 to February 2008, were identified by the Department of Microbiology. Each patient's medical notes and charts were reviewed in turn. Patients with a positive assay within 48 h of NICU admission were excluded.


RESULTS
Twenty-one (0.6%) NICU patients developed CDAD. All were emergency admissions, 18 (86.0%) were neurosurgical. Subarachnoid hemorrhage was the most common diagnosis, 5 (23.8%) patients. Median age and APACHE II score on admission were 55 (IQR 40-66) and 21 (IQR 16-24), respectively. Thirteen (61.9%) patients were female. Median interval between NICU admission and diarrhea onset and CDAD diagnosis were 5 (3-8) days and 7 (4-12) days, respectively. At the time of diagnosis most, 11 (52.4%) patients, had moderate CDAD. Previously identified risk factors for ICU-acquired CDAD comprised: age > 65 (6), antibiotics (21), and medical device requirements (21). Five (23.8%) patients deteriorated clinically as a result of CDAD. The overall in-hospital mortality for those with NICU acquired CDAD was 19%.


CONCLUSIONS
Although CDAD is rarely acquired on the NICU, up to one quarter of affected patients may experience complications. Prospective validation of severity definitions and treatment guidelines may help to reduce the complication rates.
Musa
S A
SA
Department of Gastroenterology and Hepatology, St. George's Hospital, Tooting, London, SW17 0QT, UK. catchMusa@hotmail.com
Robertshaw
H
H
Thomson
S J
SJ
Cowan
M L
ML
Rahman
T M
TM
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D016360:Clostridioides difficile; D003428:Cross Infection / Q000453:epidemiology / Q000503:physiopathology; D003967:Diarrhea / Q000175:diagnosis / Q000382:microbiology; D004636:Emergency Service, Hospital; D004761:Enterocolitis, Pseudomembranous / Q000150:complications / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D004864:Equipment and Supplies / Q000009:adverse effects; D005260:Female; D006748:Hospital Departments; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000601:surgery; D009493:Neurosurgery; D010343:Patient Admission; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D013345:Subarachnoid Hemorrhage / Q000601:surgery; D013997:Time Factors
D000900:Anti-Bacterial Agents