title: Epidemiological study of Clostridium difficile infection in critical patients admitted to the Intensive Care Unit.
abstract: Data on the epidemiology of infections caused by Clostridium difficile (CDI) in critically ill patients are scarce and center on studies with a limited time framework and/or epidemic outbreaks.
  
  
  OBJECTIVE
  To describe the characteristics and risk factors of critically ill patients admitted to the ICU with CDI, as well as the treatments used for the control of such infections.
  
  
  METHODS
  A retrospective study was made of patients included in the ENVIN-ICU registry with CDI in 2012. Patients were followed up to 72 h after discharge from the ICU. A case report form was used to record the following data: demographic variables, risk factors related to CDI, treatment and outcome. Infections were classified as community-acquired, nosocomial out-ICU and nosocomial in-ICU, according to the day on which Clostridium difficile isolates were obtained. Infection rates as episodes per 10,000 days of ICU stay are presented. The global in-ICU and hospital mortality rates were calculated.
  
  
  RESULTS
  Sixty-eight episodes of CDI in 33 out of a total of 173 ICUs participating in the registry were recorded (19.1%) (2.1 episodes per 10,000 days of ICU stay). Forty-five patients were men (66.2%), with a mean (SD) age of 63.4 (16.4) years, a mean APACHE II score on ICU admission of 19.9 (7.4), and an underlying medical condition in 44 (64.7%). Sixty-two patients (91.2%) presented more than 3 liquid depositions/day, 40 (58.8%) in association with severe sepsis or septic shock. Community-acquired infection occurred in 13 patients (19.1%), nosocomial out-ICU infection in 13 (19.1%), and in-ICU infection in 42 (61.8%). Risk factors included age>64 years in 39 cases (57.4%), previous hospital admission (3 months) in 32 (45.6%), use of antimicrobials (previous 7 days) in 57 (83.8%), enteral nutrition in 23 (33.8%), and the use of H2 inhibitors in 39 (57.4%). Initial combined treatment was administered to 18 patients (26.5%). Metronidazole was used in 60 (88.2%) and vancomycin in 31 (45.6%). The in-ICU mortality rate was 25.0% (n=17), with a hospital mortality 27.9% (n=19).
  
  
  CONCLUSIONS
  The rate of ICD in ICU patients is low, the infection affects severely ill patients, and is associated with high mortality. The presence of CDI is a marker of poor prognosis.
authors: Servicio de Medicina Intensiva, Hospital del Mar, Parc de Salut Mar, Barcelona, España. Electronic address: Falvarez@parcdesalutmar.cat.
authors: F
authors: F
authors: Alvarez-Lerma
authors: Servicio de Medicina Intensiva, Hospital Arnau de Vilanova, Lleida, España.
authors: M
authors: M
authors: Palomar
authors: Servicio de Medicina Intensiva, Hospital del Mar, Parc de Salut Mar, Barcelona, España.
authors: A
authors: A
authors: Villasboa
authors: Servicio de Medicina Intensiva, Hospital de Terrassa, Terrassa, Barcelona, España.
authors: J
authors: J
authors: Amador
authors: Servicio de Medicina Intensiva, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Barcelona, España.
authors: J
authors: J
authors: Almirall
authors: Servicio de Medicina Intensiva, Hospital Xeral Cíes, Vigo, Pontevedra, España.
authors: M P
authors: MP
authors: Posada
authors: Servicio de Medicina Intensiva, Hospital 12 de Octubre, Madrid, España.
authors: M
authors: M
authors: Catalan
authors: Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Asturias, España.
authors: C
authors: C
authors: Pascual
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000453:epidemiology*; D016638:Critical Illness; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Clostridium difficile; Critically ill patients; ENVIN-UCI; Intensive Care Unit; Paciente crítico; Unidad de Cuidados Intensivos