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Abstract

Introduction: Hospitalized patients with Clostridium difficile infection (CDI) have high rates of morbidity and mortality; however, the incidence and risk factors for hospital mortality among critically ill patients with this condition have not been systematically evaluated. The purpose of this analysis is to further define CDI epidemiology. Hypothesis: To describe the incidence of CDI and its associated morbidity and mortality in adult ICU patients at three academic institutions. Methods: This was a retrospective multicenter cohort analysis from 2009-2010 that evaluated 5,852 patients. The diagnosis of CDI was based on a positive stool toxin test. Included CDI episodes occurred during ICU stay or a period of up to 30 days after discharge from the ICU or hospital, whichever was sooner. Categorical variables were analyzed using the Chi-square test. Continuous variables were analyzed using the Student’s t-test for parametric data or the Mann-Whitney U test for nonparametric data. Results: Of the 5852 evaluated ICU patients, 386 (6.6%) had CDI. Patients with and without CDI were similar in age, gender, and ICU location. The overall rate of CDI was 5.4 cases per 1000 ICU days. Median (IQR) in-hospital treatment duration was 11 days (5-16), with 94.1%, 48.6%, and 46.8% receiving metronidazole, oral vancomycin, or combination therapy, respectively. Median (IQR) days of hospital and ICU length of stay were 23 (12-37) vs. 15 (9-25) and 12 (5-22) vs. 8 (5-15) for CDI vs. no-CDI, respectively (p<0.001 for both comparisons). Hospital mortality was 25.1% for CDI vs. 26.4% for no-CDI (p = NS). Stratification by APACHE II score did not alter this finding. Home discharge disposition was 26.1% for CDI patients vs. 32.9% for patients without CDI (p = 0.005). After discharge, skilled-nursing facility-like placement occurred in 42.4% of CDI patients vs. 31.9% of patients without CDI (p < 0.001). Conclusions: The incidence of CDI in critically ill adults was relatively low. CDI patients had significantly greater hospital and ICU LOS with resultant dependency on higher-level care after discharge. These findings may used to determine the impact of CDI on healthcare resources.