title: Predictors of Clostridium difficile infection severity in patients hospitalised in medical intensive care.
abstract: OBJECTIVE
  To describe and analyse factors associated with Clostridium difficile infection (CDI) severity in hospitalised medical intensive care unit patients.
  
  
  METHODS
  We performed a retrospective cohort study of 40 patients with CDI in a medical intensive care unit (MICU) at a French university hospital. We include patients hospitalised between January 1, 2007 and December 31, 2011. Data on demographics characteristics, past medical history, CDI description was collected. Exposure to risk factors associated with CDI within 8 wk before CDI was recorded, including previous hospitalisation, nursing home residency, antibiotics, antisecretory drugs, and surgical procedures.
  
  
  RESULTS
  All included cases had their first episode of CDI. The mean incidence rate was 12.94 cases/1000 admitted patients, and 14.93, 8.52, 13.24, 19.70, and 8.31 respectively per 1000 admitted patients annually from 2007 to 2011. Median age was 62.9 [interquartile range (IQR) 55.4-72.40] years, and 13 (32.5%) were women. Median length of MICU stay was 14.0 d (IQR 5.0-22.8). In addition to diarrhoea, the clinical symptoms of CDI were fever (> 38 °C) in 23 patients, abdominal pain in 15 patients, and ileus in 1 patient. The duration of diarrhoea was 13.0 (8.0-19.5) d. In addition to diarrhoea, the clinical symptoms of CDI were fever (> 38 °C) in 23 patients, abdominal pain in 15 patients, and ileus in 1 patient. Prior to CDI, 38 patients (95.0%) were exposed to antibiotics, and 12 (30%) received at least 4 antibiotics. Fluoroquinolones, 3(rd) generation cephalosporins, coamoxiclav and tazocillin were prescribed most frequently (65%, 55%, 40% and 37.5%, respectively). The majority of cases were hospital-acquired (n = 36, 90%), with 5 cases (13.9%) being MICU-acquired. Fifteen patients had severe CDI. The crude mortality rate within 30 d after diagnosis was 40% (n = 16), with 9 deaths (9 over 16; 56.3%) related to CDI. Of our 40 patients, 15 (37.5%) had severe CDI. Multivariate logistic regression showed that male gender [odds ratio (OR): 8.45; 95%CI: 1.06-67.16, P = 0.044], rising serum C-reactive protein levels (OR = 1.11; 95%CI: 1.02-1.21, P = 0.021), and previous exposure to fluoroquinolones (OR = 9.29; 95%CI: 1.16-74.284, P = 0.036) were independently associated with severe CDI.
  
  
  CONCLUSIONS
  We report predictors of severe CDI not dependent on time of assessment. Such factors could help in the development of a quantitative score in ICU's patients.
authors.affiliation: Nagham Khanafer, Philippe Vanhems, Laboratory of Epidemiology and Public Health, CNRS UMR 5558, University of Lyon, 69 373 Lyon, France.
authors.forename: Nagham
authors.initials: N
authors.lastname: Khanafer
authors.forename: Abdoulaye
authors.initials: A
authors.lastname: Touré
authors.forename: Cécile
authors.initials: C
authors.lastname: Chambrier
authors.forename: Martin
authors.initials: M
authors.lastname: Cour
authors.forename: Marie-Elisabeth
authors.initials: ME
authors.lastname: Reverdy
authors.forename: Laurent
authors.initials: L
authors.lastname: Argaud
authors.forename: Philippe
authors.initials: P
authors.lastname: Vanhems
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D016009:Chi-Square Distribution; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003428:Cross Infection / Q000097:blood / Q000175:diagnosis / Q000382:microbiology* / Q000401:mortality; D004761:Enterocolitis, Pseudomembranous / Q000097:blood / Q000175:diagnosis / Q000382:microbiology* / Q000401:mortality; D005260:Female; D005602:France / Q000453:epidemiology; D006760:Hospitalization; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D015854:Up-Regulation
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; D002097:C-Reactive Protein
keywords: Clostridium difficile; Health-care associated infection; Hospital-acquired infection; Intensive care unit; Nosocomial infection; Severe Clostridium difficile infection