Evaluation of nutrition therapy in critically ill patients with Clostridioides difficile infection

Nutrition therapy in the intensive care unit (ICU) is a fundamental aspect of care, but there is minimal guidance for patients with Clostridioides difficile infection (CDI) despite the potentially severe consequences of this infection on the gastrointestinal tract. The aim of this study was to assess nutrition therapy in critically ill patients with CDI compared to those without CDI for differences in nutrition delivery, need for nutrition support, and safety of nutrition therapy.

This was a single-center, retrospective cohort study of patients admitted to the ICU from January 1, 2013, through December 31, 2022. This study compared nutrition therapy in critically ill patients who had CDI compared to a cohort who had diagnoses of other infections. Outcomes included doses of nutrition prescribed, need for nutrition support, and measures of enteral feeding tolerance.

A total of 66 patients were included in this study, 33 in each group. The CDI group received higher median maximum calories (24.3 kcal/kg/day) compared to the control group (21.7 kcal/kg/day) [MD 3.5, 95 % CI 0.05-7.49, p = 0.04] and higher median maximum protein doses (1.1 g/kg/day) to (0.9 g/kg/day) [MD 0.2, 95 % CI 0.04-0.38, p = 0.02]. In the CDI group, significantly more patients required nutrition support (75.8 % and 48.5 %, respectively) [OR 3.32, 95 % CI 1.16-9.84, p = 0.02], but there was no difference in the number of patients who received parenteral nutrition. Measures of enteral feeding safety and tolerance were similar between both groups.

Nutrition therapy for critically ill patients did not appear to be negatively impacted by CDI, and provision of diet or enteral nutrition therapy appeared similarly safe and tolerated compared to those without CDI.