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Analysis of 30-day mortality for clostridium difficile-associated disease in the ICU setting
Claire Kenneally1, Jamie M Rosini, Lee P Skrupky
1Washington University School of Medicine, 660 South Euclid Ave, Campus Box 8052, St. Louis, MO 63110, USA.
Insights
Patients with Clostridium difficile-associated disease (CDAD) in the ICU have a high 30-day mortality rate. Infection control is crucial to minimize CDAD
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Hospital Epidemiology
Background:
- Clostridium difficile-associated disease (CDAD) is a significant nosocomial infection.
- Patients in intensive care units (ICUs) are particularly vulnerable to severe outcomes from CDAD.
Purpose of the Study:
- To determine the 30-day mortality rate for patients with CDAD admitted to an ICU.
- To identify independent predictors of mortality in this patient population.
Main Methods:
- Retrospective, single-center cohort study of adult ICU patients diagnosed with CDAD.
- Data collected from hospital, microbiology, and pharmacy databases.
- Logistic regression analysis used to identify mortality predictors.
Main Results:
- Overall 30-day mortality was 36.7% among 278 identified patients.
- Septic shock, ward-to-ICU transfer, and higher APACHE II scores predicted mortality.
- CDAD was associated with increased ICU (2.2 days) and hospital (4.5 days) length of stay.
Conclusions:
- A high crude 30-day mortality exists for ICU patients with CDAD.
- While attributable mortality is low, CDAD increases length of stay and morbidity.
- Routine infection control measures in ICUs are essential to reduce CDAD occurrence and its associated burden.
Objective:
To examine the 30-day mortality rate among patients with Clostridium difficile-associated disease (CDAD) requiring intensive care.
Design:
A retrospective, single-center, observational, cohort study.
Setting:
Barnes-Jewish Hospital, a 1,200-bed, urban, teaching facility.
Patients:
Adult patients admitted to the ICU identified to have CDAD by enzyme immunoassay.
Interventions:
Retrospective data collection from automated hospital, microbiology, and pharmacy databases.
Measurements And Main Results:
Two hundred seventy-eight patients with CDAD admitted to an ICU were identified over a 2-year period. Two hundred six patients (74.1%) received prior antibiotic therapy. The overall 30-day mortality rate was 36.7% (n = 102). Logistic regression analysis identified septic shock (adjusted odds ratio, 1.96; 95% confidence interval [CI], 1.47 to 2.61; p = 0.018), ward-to-ICU transfer (adjusted odds ratio, 2.12; 95% CI, 1.62 to 2.79; p = 0.006), and increasing APACHE (acute physiology and chronic health evaluation) II scores (1-point increments) [adjusted odds ratio, 1.09; 95% CI, 1.07 to 1.12; p < 0.001] as independent predictors for 30-day mortality. The attributable mortality associated with CDAD was estimated to be 6.1% (95% CI, - 1.7 to 13.9%; p = 0.127). CDAD was associated with an excess ICU length of stay (2.2 days) and hospital length of stay (4.5 days).
Conclusions:
We found a high 30-day crude mortality among patients with CDAD in the ICU setting. Although the attributable mortality from CDAD was relatively low, excess length of stay in the ICU and hospital was observed with CDAD. ICUs should routinely employ infection control efforts aimed at minimizing the occurrence of CDAD because of the excess morbidity associated with this nosocomial infection.
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