Abstract
While early empiric antibiotic therapy is beneficial for patients presenting with sepsis, the presentation of sepsis from Clostridioides difficile (formerly Clostridium difficile) infection (CDI) has not been well studied in large cohorts. We sought to determine whether the combination of extreme leukocytosis and diarrhea was strongly predictive of CDI in a cohort of 8659 patients admitted to the intensive care unit. We found that CDI was present in 15.0% (95% CI, 12.1–18.3%) of patients with extreme leukocytosis and diarrhea and that mortality for those with CDI, diarrhea, and extreme leukocytosis was 33.8% (95% CI, 23.2–44.3%). These data support consideration of empiric treatment for CDI in unstable critically ill patients with extreme leukocytosis and diarrhea, along with treatment of other possible sources of sepsis as appropriate. Empiric treatment for CDI can usually be discontinued promptly, along with narrowing of other broad-spectrum antimicrobial coverage, if a sensitive C. difficile test is negative.
Highlights
Clostridioides difficile infection (CDI) is a leading cause of healthcare-associated infections worldwide [1] and is associated with substantial excess mortality [2]
Of the 534 patients with extreme leukocytosis within three days prior to CDI testing as well as diarrhea, 80 had CDI, corresponding to a prevalence of 15.0%
The prevalence of CDI in patients with extreme leukocytosis and diarrhea undergoing repeat testing during the same or subsequent ICU stay who had not previously tested positive was 6.1%
Summary
Clostridioides difficile (formerly Clostridium difficile) infection (CDI) is a leading cause of healthcare-associated infections worldwide [1] and is associated with substantial excess mortality [2]. 35,000/μL)” [5], and in a study of physicians prescribing patterns for patients being tested for CDI, leukocytosis was found to have the strongest influence on the decision to treat CDI empirically [6]. In this large observational study, our primary aims were to determine the prevalence of CDI in ICU patients with extreme leukocytosis and diarrhea and to assess the mortality rate for patients who test positive for CDI. The findings of our study are relevant to providers deciding whether to initiate empiric treatment for CDI (alongside broadspectrum antibiotics for other suspected pathogens) for unstable ICU patients with extreme leukocytosis and diarrhea, especially because delays in treatment of CDI may increase mortality [8]
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 call
