Abstract
Critical patients are susceptible to Clostridium difficile infections (CDIs), which cause significant morbidity and mortality in the hospital. In Taiwan, the epidemiology of CDI in intensive care units (ICUs) is not well understood. This study was aimed to describe the incidence and the characteristics of CDI in the ICUs of a medical center in southern Taiwan. Adult patients with diarrhea but without colostomy/colectomy or laxative use were enrolled. Stool samples were collected with or without 5 ml alcohol and were plated on cycloserine-cefoxitin-fructose agar. C. difficile identification was confirmed by polymerase chain reaction. There were 1,551 patients admitted to ICUs, 1,488 screened, and 145 with diarrhea. A total of 75 patients were excluded due either to laxative use, a lack of stool samples, or refusal. Overall, 70 patients were included, and 14 (20%) were diagnosed with CDI, with an incidence of 8.8 cases per 10,000 patient-days. The incidence of CDI was found to be highest in March 2013 and lowest in the last quarter of 2013. The cases were categorized as the following: 5 severe, complicated, 5 severe, and 4 mild or moderate diseases. Among the 14 cases of CDI, the median patient age was 74 (range: 47–94) years, and the median time from admission to diarrhea onset was 16.5 (4–53) days. Eight cases received antimicrobial treatment (primarily metronidazole), and the time to diarrheal resolution was 11.5 days. Though 6 cases were left untreated, no patients died of CDI. The in-hospital mortality of CDI cases was 50%, similar to that of patients without CDI (46.4%; P = 1.0). We concluded that the overall incidence of CDI in our medical ICUs was low and there were variable seasonal incidences and disease severities of CDI.
Highlights
Diarrhea is common in critically ill patients, with a reported prevalence rate of 14–21% [1]
Many details of the complex pathogenesis of Clostridium difficile infections (CDIs) remain under investigation, such as the receptors that mediate toxin endocytosis, the pathogenic role of binary toxin, the innate immune responses that affect the course of CDI, and the factors related to the sporulation and germination of C. difficile in the intestine [3]
The present study aims to investigate seasonal variations in CDI incidence and its clinical manifestations, including disease severity, in intensive care units (ICUs) patients
Summary
Diarrhea is common in critically ill patients, with a reported prevalence rate of 14–21% [1]. It is a challenge for physicians in intensive care units (ICUs) due to its variety of etiologies and its complex relationship with underlying illnesses. Many details of the complex pathogenesis of CDI remain under investigation, such as the receptors that mediate toxin endocytosis, the pathogenic role of binary toxin, the innate immune responses that affect the course of CDI, and the factors related to the sporulation and germination of C. difficile in the intestine [3]. Ill patients often share one or some of the above factors, and the incidence of CDI in ICUs is expected to be high
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
