Utility of Clostridium difficile severity criteria in the ICU: a multicentre retrospective cohort study
CCCF ePoster library. Mazzetti A. Oct 3, 2017; 198113; 74
Adam Mazzetti
Adam Mazzetti
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Utility of Clostridium difficile severity criteria in the ICU: a multicentre retrospective cohort study

Mazzetti, Adam1, Duan, Erick1, 2, Heels-Ansdell, Diane2, Johnstone, Jennie3, Daneman, Nick3, Mertz, Dominik1,2, Cook, Deborah1,2




  1. Department of Medicine, McMaster University, Hamilton, Ontario

  2. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario

  3. Department of Medicine, University of Toronto, Toronto, Ontario


Introduction: Clostridium difficile infection (CDI) is a common, potentially deadly hospital-associated infection that can complicate critical illness. Published CDI severity criteria attempt to risk stratify patients with CDI and suggest an initial treatment regimen; however, whether the criteria and management guidelines apply to infections developing in critically ill patients is uncertain.
 
Objective: To characterize patients with ICU-acquired CDI and determine the utility of published severity criteria in predicting hospital mortality.
 
Methods: We conducted a retrospective cohort study of adults with ICU-acquired CDI in 3 university-affiliated hospitals from 2010-2015. Patients were identified using standardized Ontario surveillance criteria from local infection control databases. We collected data from hospital records and applied 3 severity criteria from the American College of Gastroenterology (ACG), Society for Healthcare Epidemiology of America/Infectious Diseases Society of America (SHEA/IDSA), and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID).
 
Results: Among 111 patients with ICU-acquired CDI, the mean (SD) age was 65.1 years (16.3) with a mean APACHE II score of 21.3 (7.0).  Most patients received invasive mechanical ventilation (102, 91.9%), while 66 (59.5%) had shock requiring vasopressors, and 25 (22.5%) received renal replacement therapy. The median (Q1, Q3) time to CDI diagnosis from ICU admission was 11 days (9,22). Prior to CDI, 110 (99.1%) patients received at least one antibiotic for a median of 11 days (7,18); 108 (97.3%) received proton pump inhibitors and 14 (12.6%) received histamine-2 receptor antagonists. ICU and hospital mortality were 21.6% (n=24) and 33.3% (n=37), respectively. ICU and hospital lengths of stay were 16 days (10,31) and 39 days (24,77), respectively. CDI recurred in 20 patients (18.0%).  Hospital mortality for patients with non-severe vs severe CDI according to these 3 illness severity criteria were: ACG: 23.0% (14/61) vs. 46.0 %, (23/50), p=0.01; SHEA/IDSA: 19.0% (8/42) vs 42.0% (29/69), p=0.01; and ESCMID: 26.6% (17/64) vs 42.6% (20/47), p=0.08 (Table 1).
 
Conclusions: In this 3-center study, almost all patients with ICU-acquired CDI received invasive mechanical ventilation, antibiotics and proton pump inhibitors. ACG and SHEA/IDSA severity criteria may be useful for stratifying patients with ICU-acquired CDI based on the risk of death in hospital. 

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