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Updated: Jun 10, 2026
Culturing and Maintaining Clostridium difficile in an Anaerobic Environment
Published on: September 14, 2013
Clostridium difficile-associated disease acquired in the cardiothoracic intensive care unit
Saif A Musa1, Carl Moran, Sam J Thomson
1Department of Gastroenterology and Hepatology, St George's Hospital, London, UK. catchMusa@hotmail.com
Insights
Clostridium difficile-associated disease (CDAD) is rarely acquired in the cardiothoracic intensive care unit (CTICU). However, CDAD can progress, with over a quarter of patients dying within 30 days.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Gastroenterology
Background:
- Clostridium difficile-associated disease (CDAD) poses a significant threat in intensive care settings.
- Understanding CDAD acquisition in specialized units like the cardiothoracic intensive care unit (CTICU) is crucial for patient outcomes.
Purpose of the Study:
- To investigate the prevalence, severity, and mortality associated with CDAD acquired within the CTICU.
- To identify risk factors and disease progression in CTICU patients diagnosed with CDAD.
Main Methods:
- A 5-year retrospective study was conducted.
- Data were collected from CTICU patients with a positive C. difficile stool toxin assay.
- Medical records were reviewed to gather information on patient demographics, diagnoses, interventions, and outcomes.
Main Results:
- The incidence of CTICU-acquired CDAD was 0.5% (27 out of 5,199 patients).
- The median age of affected patients was 74 years, with a majority being male surgical patients.
- A significant proportion of patients (30%) experienced disease progression, and the 30-day in-hospital mortality rate was 26%.
Conclusions:
- CDAD is infrequently acquired in the CTICU, but carries a high risk of progression and mortality.
- Established risk factors like advanced age and antibiotic use were prevalent in affected patients.
- Further prospective studies are warranted to evaluate interventions aimed at reducing CDAD complications in this vulnerable population.
Objectives:
To determine the prevalence, severity, and outcome associated with Clostridium difficile-associated disease (CDAD) acquired while in the cardiothoracic intensive care unit (CTICU).
Design:
A 5-year retrospective study.
Setting:
The CTICU.
Participants:
All CTICU patients with a positive C difficile stool toxin assay 48 hours after admission.
Interventions:
None.
Measurements And Main Results:
The results of all CTICU patients with a positive C difficile stool toxin assay were obtained from the Microbiology Department. Each patient's medical notes and charts then were reviewed in turn. A total of 27 of 5,199 (0.5%) CTICU patients acquired CDAD. The median age was 74 years (IQR 68-77), and 17 (63%) patients were male. There were 21 (78%) surgical patients; 13 (62%) were elective admissions. The most frequent diagnosis on admission was valvular heart disease (10 [37%] patients). Sixteen (59%) patients underwent coronary artery bypass graft (CABG) surgery and/or valvular heart surgery. The median interval between CTICU admission and CDAD diagnosis was 10 days (IQR 5-18). Previously identified risk factors for ICU-acquired CDAD included age >65 years (23), antibiotic use (26), and medical device requirements (27). At the time of diagnosis, 14 (52%) patients had moderate CDAD. After treatment initiation, 8 (30%) patients developed worsening CDAD. The 30-day in-hospital mortality rate for CTICU-acquired CDAD was 26% (7 patients).
Conclusions:
C difficile-associated disease rarely is acquired in the CTICU. Approximately one third of patients may experience disease progression, and just over a quarter may die within 30 days of diagnosis. The implementation of recommended severity definitions and treatment algorithms may reduce complication rates and merits prospective evaluation.
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