title: Clostridium difficile colitis acquired in the intensive care unit: outcome and prognostic factors.
abstract: OBJECTIVE
  We assessed factors associated with mortality and complicated course in the case of Clostridium difficile infection (CDI) acquired in the intensive care unit (ICU).
  
  
  METHODS
  Retrospective cohort study conducted from 1 January 2002 through 1 January 2012. All patients who acquired CDI in our ICU were included.
  
  
  RESULTS
  Thirty-one patients were included. Twenty patients (65 %) had mild colitis, 8 (25 %) moderate colitis, and 3 (10 %) severe colitis. Initial antibiotherapy was metronidazole (n = 30, 97 %) and vancomycin (n = 1, 3 %). Seventeen patients (55 %) experienced at least one complication: failure of initial treatment (n = 16, 52 %), shock (n = 11, 34 %), need for surgery (n = 1, 3 %) or renal replacement (n = 4, 13 %), or death (n = 8, 26 %). Risk factors of ICU mortality were history of corticosteroids prescription, prolonged ICU stay, low serum albumin level, and high Sequential Organ Failure Assessment (SOFA) score at the time of CDI diagnosis. Factors associated with a complicated course were high Simplified Acute Physiology Score (SAPS II), high SOFA score, and low serum albumin level at the time of CDI onset.
  
  
  CONCLUSIONS
  Risk factors of poor outcome in patients with CDI acquired in the ICU are different from those in the general population suffering from CDI. The implementation of treatment algorithms taking into account these factors may reduce complication rates in this specific population.
authors.affiliation: Service de Réanimation et Maladies Infectieuses, Hôpital Dron, 128 avenue du Président Coty, 59200, Tourcoing, France.
authors.forename: L
authors.initials: L
authors.lastname: Sabau
authors.forename: A
authors.initials: A
authors.lastname: Meybeck
authors.forename: J
authors.initials: J
authors.lastname: Gois
authors.forename: P
authors.initials: P
authors.lastname: Devos
authors.forename: P
authors.initials: P
authors.lastname: Patoz
authors.forename: N
authors.initials: N
authors.lastname: Boussekey
authors.forename: P-Y
authors.initials: PY
authors.lastname: Delannoy
authors.forename: A
authors.initials: A
authors.lastname: Chiche
authors.forename: H
authors.initials: H
authors.lastname: Georges
authors.forename: O
authors.initials: O
authors.lastname: Leroy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality / Q000473:pathology; D015331:Cohort Studies; D003092:Colitis / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality / Q000473:pathology; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome