title: Clostridium difficile Infections after Blunt Trauma: A Different Patient Population?
abstract: BACKGROUND
  The epidemiology of Clostridium difficile-associated infection (CDI) has changed, and it is evident that susceptibility is related not only to exposures and bacterial potency, but host factors as well. Several small studies have suggested that CDI after trauma is associated with a different patient phenotype. The purpose of this study was to examine and describe the epidemiologic factors associated with C. difficile in blunt trauma patients without traumatic brain injury using the Trauma-Related Database as a part of the "Inflammation and Host Response to Injury" (Glue Grant) and the University of Florida Integrated Data Repository.
  
  
  METHODS
  Previously recorded baseline characteristics, clinical data, and outcomes were compared between groups (67 C. difficile and 384 uncomplicated, 813 intermediate, and 761 complicated non-C. difficile patients) as defined by the Glue Grant on admission and at days seven and 14.
  
  
  RESULTS
  The majority of CDI patients experienced complicated or intermediate clinical courses. The mean ages of all cohorts were less than 65 y and CDI patients were significantly older than uncomplicated patients without CDI. The CDI patients had increased days in the hospital and on the ventilator, as well as significantly higher new injury severity scores (NISS), and a greater percentage of patients with NISS >34 points compared with non-CDI patients. They also had greater Marshall and Denver multiple organ dysfunction scores than non-CDI uncomplicated patients, and greater creatinine, alkaline phosphatase, neutrophil count, lactic acid, and PiO2:FiO2 compared with all non-CDI cohorts on admission. In addition, the CDI patients had higher glucose concentrations and base deficit from uncomplicated patients and greater leukocytosis than complicated patients on admission. Several of these changes persisted to days seven and 14.
  
  
  CONCLUSIONS
  Analysis of severe blunt trauma patients with C. difficile, as compared with non-CDI patients, reveals evidence of increased inflammation, immunosuppression, worse acute kidney injury, higher NISS, greater days in the hospital and on the ventilator, higher organ injury scores, and prolonged clinical courses. This supports reports of an increased prevalence of CDI in a younger population not believed previously to be at risk. This unique population may have specific genomic or inflammation-related risk factors that may play more important roles in disease susceptibility. Prospective analysis may allow early identification of at-risk patients, creation of novel therapeutics, and improved understanding of how and why C. difficile colonization transforms into infection after severe blunt trauma.
authors.affiliation: 1 Department of Surgery, College of Medicine, University of Florida , Gainesville, Florida.
authors.forename: Erin L
authors.initials: EL
authors.lastname: Vanzant
authors.affiliation: 2 Department of Anesthesiology, College of Medicine, University of Florida , Gainesville, Florida.
authors.forename: Tezcan
authors.initials: T
authors.lastname: Ozrazgat-Baslanti
authors.affiliation: 1 Department of Surgery, College of Medicine, University of Florida , Gainesville, Florida.
authors.forename: Huazhi
authors.initials: H
authors.lastname: Liu
authors.affiliation: 2 Department of Anesthesiology, College of Medicine, University of Florida , Gainesville, Florida.
authors.forename: Seemab
authors.initials: S
authors.lastname: Malik
authors.affiliation: 1 Department of Surgery, College of Medicine, University of Florida , Gainesville, Florida.
authors.forename: Ruth
authors.initials: R
authors.lastname: Davis
authors.affiliation: 1 Department of Surgery, College of Medicine, University of Florida , Gainesville, Florida.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Lanz
authors.affiliation: 1 Department of Surgery, College of Medicine, University of Florida , Gainesville, Florida.
authors.forename: Makesha V
authors.initials: MV
authors.lastname: Miggins
authors.affiliation: 1 Department of Surgery, College of Medicine, University of Florida , Gainesville, Florida.
authors.forename: Lori F
authors.initials: LF
authors.lastname: Gentile
authors.affiliation: 1 Department of Surgery, College of Medicine, University of Florida , Gainesville, Florida.
authors.forename: Angela
authors.initials: A
authors.lastname: Cuenca
authors.affiliation: 1 Department of Surgery, College of Medicine, University of Florida , Gainesville, Florida.
authors.forename: Alex G
authors.initials: AG
authors.lastname: Cuenca
authors.affiliation: 1 Department of Surgery, College of Medicine, University of Florida , Gainesville, Florida.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Lottenberg
authors.affiliation: 1 Department of Surgery, College of Medicine, University of Florida , Gainesville, Florida.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Moore
authors.affiliation: 1 Department of Surgery, College of Medicine, University of Florida , Gainesville, Florida.
authors.forename: Darwin N
authors.initials: DN
authors.lastname: Ang
authors.affiliation: 2 Department of Anesthesiology, College of Medicine, University of Florida , Gainesville, Florida.
authors.forename: Azra
authors.initials: A
authors.lastname: Bihorac
authors.affiliation: 1 Department of Surgery, College of Medicine, University of Florida , Gainesville, Florida.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Efron
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000150:complications / Q000453:epidemiology; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000150:complications* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007249:Inflammation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000453:epidemiology*; D055815:Young Adult