Clostridium difficile Associated Disease in a Neurointensive Care Unit

Abstract

Background: Critically ill patients are at high risk for acquiring Clostridium difficile infection. The aim of this study was to investigate the prevalence, severity, and outcome of neurointensive care unit (NICU) acquired Clostridium difficile associated disease (CDAD).Materials and Methods: Intensive care admission and hospital infection control databases from April 2008 to August 2010 were studied and the case notes reviewed retrospectively. Diarrhea was classified as mild, moderate, or severe based on the frequency and volume. Information on demographics, risk factors for CDAD, presentation, and course of the disease was gathered. Admission diagnosis, days of NICU stay, and incidence of complications were noted.Results: In the time period studied, 9 out of 2212 patients (prevalence rate 0.4%) admitted to the intensive care unit (ICU) for a total of 10,825 bed days (incidence rate 8.3 per 10,000 bed days) acquired CDAD. Median age was 55 (IQR 20–72) years. The median NICU stay was 26 (IQR 11–103) days. The median duration between ICU admission and development of CDAD was 11 (IQR 3–93) days. Four patients (44%) had moderate CDAD. Concurrent infections occurred in seven (77%) patients. The most frequently prescribed antimicrobials prior to CDAD were cephalosporins (71%). The apparent risk factors in this group included age>65 year (22%) and antibiotics (67%) among others. One patient developed CDAD colitis. Three patients had a perceived delay in discharge from the ICU (1–8 days) due to their infective status. No mortality was ascribed to CDAD.Conclusion: The prevalence rate (0.4%) and morbidity of CDAD in the unit are low. A larger database is needed to better analyze the associated risk factors in this subgroup of patients. A possible increase in disease burden due to a delay in discharge from the ICU merits further evaluation.

Prevalence and Clinical Outcomes of Clostridium difficile Infection in the Intensive Care Unit: A Systematic Review and Meta-Analysis

“…Among the 80 835 ICU patients in our analysis, the pooled prevalence of CDI was 2% (95% CI, 1%–2%; τ 2 = 0.01) (Figure 2 ), with no evidence of small study effects across studies (Egger's bias 1.53, P = .142). The prevalence of CDI across North America studies was 2% [95% CI (1%–4%), τ 2 = 0.02] [ 17 , 18 , 20 – 22 , 24 , 25 , 28 ], whereas the estimated prevalence across Europe was 1% (95% CI, 1%–2%; τ 2 = 0.01) [ 13 – 16 , 19 , 23 , 27 , 29 – 32 , 34 ] and the estimated prevalence across Asia was 3% (95% CI, 1%–2%; τ 2 = 0.01) [ 26 , 33 ]. Among 3621 diarrheic ICU patients, the pooled prevalence of CDI was 11% (95% CI, 6%–17%; τ 2 = 0.08), with no small study effect (Egger's bias 1.01, P = .156) [ 14 , 18 , 19 , 25 – 27 , 29 – 31 , 33 , 34 ] ( Supplementary Figure 3 ).…”

“…Based on 4 studies [ 26 , 27 , 32 , 34 ], we found that 25% (95% CI, 5%–51%; τ 2 = 0.17) of ICU patients with confirmed CDI had pseudomembranous colitis determined either with imaging or endoscopic findings [ 26 , 27 , 32 , 34 ] ( Supplementary Figure 4 ). It is worth noting that we excluded from this calculation the study by Buendgens et al [ 15 ], where only patients with pseudomembranous colitis were deemed to have CDI, in an effort to avoid overestimating the result.…”

Clostridium difficile Infections in Medical Intensive Care Units of a Medical Center in Southern Taiwan: Variable Seasonality and Disease Severity

“…The reported incidence of CDI in the ICUs of North America and Europe was 8.7–53.9 cases per 10,000 patient-days [ 8 – 12 ], or 0.4–4% of the ICU population [ 12 – 17 ]. A recent meta-analysis revealed a global CDI incidence rate of 2% among critically ill patients [ 18 ].…”

Is Clostridium difficile infection an increasingly common severe disease in adult intensive care units? A 10-year experience

“…The assessment of CDI in patients admitted to the ICU is scarce and usually refers to short periods and patients who have acquired CDI during their ICU stay; it omits CDI episodes occurring before admission or even during the first 24 to 72 hours of admission [7][8][9][10]19,[23][24][25]. We put this issue into perspective: the percentage of A-ICU CDI cases acquired before ICU admission was 16.2%; in the few studies addressing this matter, results range from 17.4% to 47% [26][27][28][29].…”