title: Epidemiology and risk factors for Clostridium difficile infection in critically ill patients in Spain: The PROCRID study.
abstract: Our objectives were to describe the incidence, clinical characteristics, and risk factors for Clostridium difficile infection (CDI) in critically ill patients and to determine C. difficile PCR-ribotypes.
  
  
  
  Prospective, observational study in 26 Spanish ICUs. Patients with diarrhea meeting ESCMID criteria for CDI were included. Molecular characterization of isolates was performed using PCR ribotyping.
  
  
  
  Of 4258 patients admitted to the ICUs, 190 (4.5%) developed diarrhea. Only 16 patients (8.4%) were diagnosed with CDI. Ribotype 078/126 (25.0%) was the most frequently identified. The mortality rate was similar in patients with ICD compared to patients with diarrhea not caused by C. difficile (p=0.115). Chronic renal insufficiency was identified as the only factor independently associated with the development of CDI (OR 5.87, 95% CI 1.24-27.83; p=0.026).
  
  
  
  The incidence of CDI in Spanish ICUs is low. Only chronic renal insufficiency was observed to be a risk factor for CDI development.
authors.affiliation: Instituto de Biomedicina de Sevilla, IBIS/Hospitales Universitarios Virgen Macarena - Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain. Electronic address: boticariors@gmail.com.
authors.forename: Antonio
authors.initials: A
authors.lastname: Gutiérrez-Pizarraya
authors.affiliation: Unidad Clínica de Cuidados Intensivos, Hospital Virgen del Rocío, Sevilla, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Martín-Villén
authors.affiliation: Microbiology Department, H. Universitario Gregorio Marañón, Madrid, Spain; Department of Medicine, Universidad Complutense, IISGM and CIBERES, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Alcalá-Hernández
authors.affiliation: Microbiology Department, H. Universitario Gregorio Marañón, Madrid, Spain; Department of Medicine, Universidad Complutense, IISGM and CIBERES, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Marín Arriaza
authors.affiliation: Intensive Medicine Department, H. Puerta de Hierro, Madrid, Spain.
authors.forename: Bárbara
authors.initials: B
authors.lastname: Balandín-Moreno
authors.affiliation: Unidad Clínica de Cuidados Intensivos, H. General Carlos Haya, Málaga, Spain.
authors.forename: César
authors.initials: C
authors.lastname: Aragón-González
authors.affiliation: Intensive Medicine Department, H. Clínico Universitario, Valencia, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Ferreres-Franco
authors.affiliation: Anaesthesia and Reanimation Department, H. Universitario La Fe, Valencia, Spain.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Chiveli Monleón
authors.affiliation: Astellas Pharma S.A., Spain.
authors.forename: Paloma
authors.initials: P
authors.lastname: Anguita-Alonso
authors.affiliation: Microbiology Department, H. Universitario Gregorio Marañón, Madrid, Spain; Department of Medicine, Universidad Complutense, IISGM and CIBERES, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Bouza-Santiago
authors.affiliation: Unidad Clínica de Cuidados Intensivos, Hospital Universitario Virgen Macarena, Sevilla, Spain; Instituto Biomedicina, Sevilla, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Garnacho-Montero
mesh_terms: D000368:Aged; D016360:Clostridioides difficile / Q000145:classification / Q000235:genetics; D003015:Clostridium Infections / Q000175:diagnosis / Q000453:epidemiology*; D016638:Critical Illness; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D021521:Ribotyping; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology
keywords: Clostridium difficile; ICU; Incidence; Incidencia; Mortalidad; Mortality; UCI