Hospital-acquired Clostridium difficile-associated disease in the intensive care unit setting:: epidemiology, clinical course and outcome

Background: Clostridium difficile-associated disease (CDAD) is a serious nosocomial infection, however few studies have assessed CDAD outcome in the intensive care unit (ICU). We evaluated the epidemiology, clinical course and outcome of hospital-acquired CDAD in the critical care setting. Methods: We performed a historical cohort study on 58 adults with a positive C. difficile cytotoxin assay result occurring in intensive care units. Results: Sixty-two percent of patients had concurrent infections, 50% of which were bloodstream infections. The most frequently prescribed antimicrobials prior to CDAD were anti-anaerobic agents (60.3%). Septic shock occurred in 32.8% of CDAD patients. The in-hospital mortality was 27.6%. Univariate analysis revealed that SOFA score, at least one organ failure and age were predictors of mortality. Charlson score >= 3, gender, concurrent infection, and number of days with diarrhea before a positive C. difficile toxin assay were not significant predictors of mortality on univariate analysis. Independent predictors for death were SOFA score at infection onset ( per 1-point increment, OR 1.40; CI95 1.13 - 1.75) and age ( per 1-year increment, OR 1.10; CI95 1.02-1.19). Conclusion: In ICU patients with CDAD, advanced age and increased severity of illness at the onset of infection, as measured by the SOFA score, are independent predictors of death.