Hospital-acquired Clostridium difficile-associated disease in the intensive care unit setting: epidemiology, clinical course and outcome

Alexandre R Marra; Michael B Edmond; Richard P Wenzel; Gonzalo M L Bearman

doi:10.1186/1471-2334-7-42

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Hospital-acquired Clostridium difficile-associated disease in the intensive care unit setting: epidemiology, clinical course and outcome

Journal article

Open access

Peer reviewed

Hospital-acquired Clostridium difficile-associated disease in the intensive care unit setting: epidemiology, clinical course and outcome

Alexandre R Marra, Michael B Edmond, Richard P Wenzel and Gonzalo M L Bearman

BMC infectious diseases, Vol.7(1), 42

05/21/2007

DOI: 10.1186/1471-2334-7-42

PMID: 17517130

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Abstract

Clostridium difficile-associated disease (CDAD) is a serious nosocomial infection, however few studies have assessed CDAD outcome in the intensive care unit (ICU). We evaluated the epidemiology, clinical course and outcome of hospital-acquired CDAD in the critical care setting. We performed a historical cohort study on 58 adults with a positive C. difficile cytotoxin assay result occurring in intensive care units. Sixty-two percent of patients had concurrent infections, 50% of which were bloodstream infections. The most frequently prescribed antimicrobials prior to CDAD were anti-anaerobic agents (60.3%). Septic shock occurred in 32.8% of CDAD patients. The in-hospital mortality was 27.6%. Univariate analysis revealed that SOFA score, at least one organ failure and age were predictors of mortality. Charlson score >/=3, gender, concurrent infection, and number of days with diarrhea before a positive C. difficile toxin assay were not significant predictors of mortality on univariate analysis. Independent predictors for death were SOFA score at infection onset (per 1-point increment, OR 1.40; CI95 1.13-1.75) and age (per 1-year increment, OR 1.10; CI95 1.02-1.19). In ICU patients with CDAD, advanced age and increased severity of illness at the onset of infection, as measured by the SOFA score, are independent predictors of death.

Intensive Care Units

Enterocolitis, Pseudomembranous - epidemiology

Humans

Middle Aged

Anti-Infective Agents - therapeutic use

Male

Treatment Outcome

Clostridium difficile - isolation & purification

Cross Infection - drug therapy

Enterocolitis, Pseudomembranous - drug therapy

Metronidazole - therapeutic use

Cross Infection - microbiology

Adult

Female

Retrospective Studies

Child

Cohort Studies

Cross Infection - epidemiology

Details

Title: Subtitle: Hospital-acquired Clostridium difficile-associated disease in the intensive care unit setting: epidemiology, clinical course and outcome
Creators: Alexandre R Marra - Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil. a.marra@uol.com.br
Michael B Edmond
Richard P Wenzel
Gonzalo M L Bearman
Resource Type: Journal article
Publication Details: BMC infectious diseases, Vol.7(1), 42
DOI: 10.1186/1471-2334-7-42
PMID: 17517130
NLM abbreviation: BMC Infect Dis
ISSN: 1471-2334
eISSN: 1471-2334
Publisher: England
Language: English
Date published: 05/21/2007
Academic Unit: Internal Medicine
Record Identifier: 9983905519302771

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