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

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2007-05-21
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Marra, Alexandre Rodrigues [UNIFESP]
Edmond, Michael B.
Wenzel, Richard P.
Bearman, Gonzalo M. L.
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Background: 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.Methods: We performed a historical cohort study on 58 adults with a positive C. difficile cytotoxin assay result occurring in intensive care units.Results: 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).Conclusion: 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.
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Bmc Infectious Diseases. London: Biomed Central Ltd, v. 7, 6 p., 2007.