title: Recurrent Clostridium difficile infection in intensive care unit patients.
abstract: BACKGROUND
  The purpose of this study was to assess the 12-week cumulative incidence of recurrent Clostridium difficile infection (rCDI) and identify risk factors for rCDI in patients that acquired index C difficile infection (CDI) while in the intensive care unit (ICU).
  
  
  METHODS
  This retrospective single-center cohort study reviewed adult patients from 6 different ICUs who developed a CDI between February 2010 and September 2013.
  
  
  RESULTS
  Out of 162 included ICU patients, 34 experienced rCDI. Risk of rCDI was higher in the ICU versus non-ICU group (21% vs 17%, P = .03). The incidence of rCDI was highest in the surgical intensive care unit (SICU) at 43.8%. A multivariable logistic regression model was constructed and identified 5 significant risk factors for rCDI: previous CDI (odds ratio [OR], 8.03; 95% confidence interval [CI], 1.90-34.02; P = .005), log10 ICU length of stay in days (OR, 3.67; 95% CI, 1.13-11.85; P = .03), acquisition of CDI in the medical intensive care unit (MICU) (OR, 5.35; 95% CI, 1.60-17.85; P = .006) or SICU (OR, 15.30; 95% CI, 4.09-57.23; P < .001), and chronic obstructive pulmonary disease (COPD) (OR, 3.55; 95% CI, 1.41-8.94; P = .007).
  
  
  CONCLUSIONS
  ICU adults had a significantly higher 12-week incidence of rCDI than non-ICU patients. Risk factors for rCDI after acquisition of infection in an ICU include MICU and SICU patients, previous CDI, COPD, and length of stay.
authors.affiliation: Department of Pharmacy Services, University of Michigan Health System, Ann Arbor, MI; College of Pharmacy, University of Michigan, Ann Arbor, MI.
authors.forename: Natalia M
authors.initials: NM
authors.lastname: Jasiak
authors.affiliation: Department of Pharmacy Services, University of Michigan Health System, Ann Arbor, MI; College of Pharmacy, University of Michigan, Ann Arbor, MI.
authors.forename: Cesar
authors.initials: C
authors.lastname: Alaniz
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI; Division of Infectious Diseases, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI.
authors.forename: Krishna
authors.initials: K
authors.lastname: Rao
authors.affiliation: College of Pharmacy, University of Michigan, Ann Arbor, MI.
authors.forename: Katherine
authors.initials: K
authors.lastname: Veltman
authors.affiliation: Department of Pharmacy Services, University of Michigan Health System, Ann Arbor, MI; College of Pharmacy, University of Michigan, Ann Arbor, MI. Electronic address: nageljl@med.umich.edu.
authors.forename: Jerod L
authors.initials: JL
authors.lastname: Nagel
mesh_terms: D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology; D015331:Cohort Studies; D003422:Critical Care; D003428:Cross Infection / Q000453:epidemiology*; D003967:Diarrhea; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Clostridium difficile; Colitis; Health care–associated infection; Intensive care unit; Recurrence