Clostridium difficile Infection Does Not Impact Outcomes in Stroke Patients

Data are limited for Clostridium difficile infection (CDI) in stroke patients. This study investigates incidence, patient characteristics, clinical features, and outcomes of CDI following stroke, including ischemic stroke (IS), intracerebral hemorrhage (ICH), and aneurysmal subarachnoid hemorrhage (SAH).

The hospital database was queried for all patients with IS, ICH, or SAH from 2010 through 2014. Patients who underwent testing for C. difficile testing (CDT) through polymerase chain reaction were assessed. Demographics, risk factors, clinical features, and outcomes were recorded. Fever was defined as temperature >101°F.

CDT was obtained in 555/4004 patients and was positive in 99, for CDI incidence of 2.5% [SAH 6.5% (26/402) vs. 2.9% in ICH (21/730) and 1.8% in IS (52/2872)]. There were no differences in demographics, severity [ICH score, National Institutes for Health Stroke Scale (NIHSS), Hunt Hess (HH), Glasgow coma scale (GCS)], mechanical ventilation, neurosurgical procedures, stress ulcer prophlyaxis or antibiotic use. Steroid use (P=0.0273) and male sex (P=0.0112) were associated with a positive CDT. On the day of diagnosis, 61% of CDT-positive patients had white blood cell <12, and 71% were afebrile. Length of stay, discharge disposition, mortality, and 3-month and 12-month modified Rankin, were not impacted by CDT results. Two patients with CDI required bowel resection.

CDI incidence following stroke was low and most common with SAH. Male sex and steroid use were associated with a positive result. Leukocytosis and fever occurred in under half of infected patients. Outcome measures were not impacted by CDI.