Outcome of ICU patients with Clostridium difficile infection

Zahar, Jean-Ralph, Schwebel, Carole, Adrie, Christophe, Garrouste-Orgeas, Maite, Francais, Adrien, Vesin, Aurelien, Nguile-Makao, Moliere, Tabah, Alexis, Laupland, Kevin, Le-Monnier, Alban and Timsit, Jean-Francois (2012) Outcome of ICU patients with Clostridium difficile infection. Critical Care, 16 6: . doi:10.1186/cc11852

Author Zahar, Jean-Ralph
Schwebel, Carole
Adrie, Christophe
Garrouste-Orgeas, Maite
Francais, Adrien
Vesin, Aurelien
Nguile-Makao, Moliere
Tabah, Alexis
Laupland, Kevin
Le-Monnier, Alban
Timsit, Jean-Francois
Title Outcome of ICU patients with Clostridium difficile infection
Formatted title
Outcome of ICU patients with Clostridium difficile infection
Journal name Critical Care   Check publisher's open access policy
ISSN 1364-8535
Publication date 2012-11-05
Year available 2012
Sub-type Article (original research)
DOI 10.1186/cc11852
Open Access Status DOI
Volume 16
Issue 6
Total pages 10
Place of publication Philadelphia, PA, United States
Publisher Current Science
Language eng
Formatted abstract
Introduction: As data from Clostridium difficile infection (CDI) in intensive care unit (ICU) are still scarce, our objectives were to assess the morbidity and mortality of ICU-acquired CDI.

Methods: We compared patients with ICU-acquired CDI (watery or unformed stools occurring ≥ 72 hours after ICU admission with a stool sample positive for C. difficile toxin A or B) with two groups of controls hospitalized at the same time in the same unit. The first control group comprised patients with ICU-acquired diarrhea occurring ≥ 72 hours after ICU admission with a stool sample negative for C. difficile and for toxin A or B. The second group comprised patients without any diarrhea.

Results: Among 5,260 patients, 512 patients developed one episode of diarrhea. Among them, 69 (13.5%) had a CDI; 10 (14.5%) of them were community-acquired, contrasting with 12 (17.4%) that were hospital-acquired and 47 (68%) that were ICU-acquired. A pseudomembranous colitis was associated in 24/47 (51%) ICU patients. The median delay between diagnosis and metronidazole administration was one day (25th Quartile; 75th Quartile (0; 2) days). The case-fatality rate for patients with ICU-acquired CDI was 10/47 (21.5%), as compared to 112/443 (25.3%) for patients with negative tests. Neither the crude mortality (cause specific hazard ratio; CSHR = 0.70, 95% confidence interval; CI 0.36 to 1.35, P = 0.3) nor the adjusted mortality to confounding variables (CSHR = 0.81, 95% CI 0.4 to 1.64, P = 0.6) were significantly different between CDI patients and diarrheic patients without CDI. Compared to the general ICU population, neither the crude mortality (SHR = 0.64, 95% CI 0.34 to 1.21, P = 0.17), nor the mortality adjusted to confounding variables (CSHR = 0.71, 95% confidence interval (CI) 0.38 to 1.35, P = 0.3), were significantly different between the two groups. The estimated increase in the duration of stay due to CDI was 8.0 days ± 9.3 days, (P = 0.4) in comparison to the diarrheic population, and 6.3 days ± 4.3 (P = 0.14) in comparison to the general ICU population.

Conclusions: If treated early, ICU-acquired CDI is not independently associated with an increased mortality and impacts marginally the ICU length of stay.
Keyword Clostridium difficile
ICU patients
Morbidity and mortality
ICU-acquired CDI
Intensive care unit
Clostridium difficile infection (CDI)
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 18 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 21 times in Scopus Article | Citations
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Created: Tue, 21 Jun 2016, 03:17:44 EST by Alexs Tabah on behalf of Learning and Research Services (UQ Library)