title: Clostridium difficile-associated disease acquired in the cardiothoracic intensive care unit.
abstract: OBJECTIVE
  To determine the prevalence, severity, and outcome associated with Clostridium difficile-associated disease (CDAD) acquired while in the cardiothoracic intensive care unit (CTICU).
  
  
  METHODS
  A 5-year retrospective study.
  
  
  METHODS
  The CTICU.
  
  
  METHODS
  All CTICU patients with a positive C difficile stool toxin assay 48 hours after admission.
  
  
  METHODS
  None.
  
  
  RESULTS
  The results of all CTICU patients with a positive C difficile stool toxin assay were obtained from the Microbiology Department. Each patient's medical notes and charts then were reviewed in turn. A total of 27 of 5,199 (0.5%) CTICU patients acquired CDAD. The median age was 74 years (IQR 68-77), and 17 (63%) patients were male. There were 21 (78%) surgical patients; 13 (62%) were elective admissions. The most frequent diagnosis on admission was valvular heart disease (10 [37%] patients). Sixteen (59%) patients underwent coronary artery bypass graft (CABG) surgery and/or valvular heart surgery. The median interval between CTICU admission and CDAD diagnosis was 10 days (IQR 5-18). Previously identified risk factors for ICU-acquired CDAD included age >65 years (23), antibiotic use (26), and medical device requirements (27). At the time of diagnosis, 14 (52%) patients had moderate CDAD. After treatment initiation, 8 (30%) patients developed worsening CDAD. The 30-day in-hospital mortality rate for CTICU-acquired CDAD was 26% (7 patients).
  
  
  CONCLUSIONS
  C difficile-associated disease rarely is acquired in the CTICU. Approximately one third of patients may experience disease progression, and just over a quarter may die within 30 days of diagnosis. The implementation of recommended severity definitions and treatment algorithms may reduce complication rates and merits prospective evaluation.
authors.affiliation: Department of Gastroenterology and Hepatology, St George's Hospital, London, UK. catchMusa@hotmail.com
authors.forename: Saif A
authors.initials: SA
authors.lastname: Musa
authors.forename: Carl
authors.initials: C
authors.lastname: Moran
authors.forename: Sam J
authors.initials: SJ
authors.lastname: Thomson
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Cowan
authors.forename: Greg
authors.initials: G
authors.lastname: McAnulty
authors.forename: Michael
authors.initials: M
authors.lastname: Grounds
authors.forename: Tony Manibur
authors.initials: TM
authors.lastname: Rahman
mesh_terms: D000368:Aged; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003325:Coronary Care Units / Q000592:standards; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000592:standards; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors