Clinical features of Clostridium difficile infection in an intensive care unit: from 2009 to 2017

Abstract

Background: The incidence, severity and mortality of Clostridium difficile infection (CDI) has been on the rise over the last 20 year and its mortality has been estimated in 6-38%. Our aims are to determine clinical characteristics of CDI and factors related to mortality in an intensive care unit (ICU). Methods & Materials: Among 1122 patients living with HIV admitted to ICU between 2009 and 2016, 60 had CDI. Univariate analysis was performed to identify death related factors. Results are expressed as percentage (%), median (Me), mean (M) and range. A p value of < 0.05 was considered significant Results: Incidence was 0,02, it was found to be 61% higher between 2014-2017. 60% men. M/Me age were 47 years. M/Me time from admission to diarrhea onset was 46/33 days. Estimated length of IC stay before CDI acquisition was M/Me 14/10 days. 93% had an underlying medical condition, 62% HIV/Aids. Use of antibiotics 95%; M/Me prior exposure of 29/19 days. 100% were undergoing gastric acid suppression (GAS). Most common symptoms/signs were: 95% diarrhea, 52% abdominal pain and 48% arterial hypotension. 90% present hypoalbuminemia less than 3,5 g/L, Me 2,2 g/L. 95% were diagnosed with enzyme immunoassays for toxins A/B. Patients developed mild/moderated CDI 38%, severe 53%, complicated 37% and 8% recurred. M/Me APACHE II score (Score Acute Physiology and Chronic Health Evaluation II) on IC admission of 19 points and M/Me SOFA (Sequential Organ Failure Assessment score) of 5 points. 7% were not treated. Overall mortality was 61%; an increased mortality 108% was noted when 2 periods were compared (2009-2013 and 2014-2017). Hypoalbuminemia (≤2,4 g/L), APACHE II > 18 points, SOFA > 5 points, severe CDI present statistically significant in mortality (p < 0,05) Conclusion: More than a half occured in HIV seropositive individuals. Almost 100% had been exposed to antibiotics and 100% to GAS. More than half were severe, a factor that as well as hypoalbuminemia, and the severity scores used in the ICU, are associated with higher mortality. Mortality associated with CDI increased during the study period and was more likely to occur in younger patients and in hospitalizations lasting longer than 4 wk.