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
Login now to access Regular content available to all registered users.

You may also access this content "anytime, anywhere" with the Free MULTILEARNING App for iOS and Android
Rate & Comment (0)

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. 

    This eLearning portal is powered by:
    This eLearning portal is powered by MULTIEPORTAL
Anonymous User Privacy Preferences

Strictly Necessary Cookies (Always Active)

MULTILEARNING platforms and tools hereinafter referred as “MLG SOFTWARE” are provided to you as pure educational platforms/services requiring cookies to operate. In the case of the MLG SOFTWARE, cookies are essential for the Platform to function properly for the provision of education. If these cookies are disabled, a large subset of the functionality provided by the Platform will either be unavailable or cease to work as expected. The MLG SOFTWARE do not capture non-essential activities such as menu items and listings you click on or pages viewed.

Performance Cookies

Performance cookies are used to analyse how visitors use a website in order to provide a better user experience.

Save Settings