Clostridium difficile infections in patients with severe burns

Crabtree, Scott; Robertson, Janelle L.; Chung, Kevin K.; Renz, Evan M.; Wolf, Steven E.; Hospenthal, Duane R.; Murray, Clinton K.

doi:10.1016/j.burns.2010.06.008

Cited by 20 publications

(9 citation statements)

References 16 publications

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“…The burn center is unique in that it had a low nursepatient staffing ratio, single-bed rooms, and a younger patient population, which is consistent with findings from a prior study. 22 Our multilevel statistical model revealed that younger age and patient pharmaceutical exposures did not completely account for the lower-than-expected incidence in the burn ICU, suggesting that other patient or ward characteristics may have been be at play.…”

Section: Discussionmentioning

confidence: 70%

Hospital Ward Antibiotic Prescribing and the Risks ofClostridium difficileInfection

et al. 2015

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IMPORTANCE Only a portion of hospital-acquired Clostridium difficile infections can be traced back to source patients identified as having symptomatic disease. Antibiotic exposure is the main risk factor for C difficile infection for individual patients and is also associated with increased asymptomatic shedding. Contact with patients taking antibiotics within the same hospital ward may be a transmission risk factor for C difficile infection, but this hypothesis has never been tested. OBJECTIVES To obtain a complete portrait of inpatient risk that incorporates innate patient risk factors and transmission risk factors measured at the hospital ward level and to investigate ward-level rates of antibiotic use and C difficile infection risk.

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Section: Discussionmentioning

confidence: 70%

Hospital Ward Antibiotic Prescribing and the Risks ofClostridium difficileInfection

et al. 2015

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“…Crabtree et al (2011) in their study report an incidence of 7.2 per 10,000 patient days in the burns ICU (BICU) and 15.5 infections in 10,000 patient days among patients in the non-BICU in spite of longer duration of stay and greater number of surgical interventions in the BICU patients who were more often young males. The rates of infection in our patients appear to be lesser than those in general ICUs and similar to the ICUs catering to patient subgroups.…”

Section: Discussionmentioning

confidence: 99%

“…Although more data is now emerging on CDAD acquired in the general ICU, the information from sub specialty ICU remains scanty (Musa et al, 2010, 2011; Crabtree et al, 2011). …”

Section: Introductionmentioning

confidence: 99%

Clostridium difficile Associated Disease in a Neurointensive Care Unit

2013

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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.

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“…The reported incidence rate of CDI in medical and/or surgical ICUs, ranging from 8.7 to 53.9 cases per 10,000 patient-days or 1.5–4.8% of ICU population [ 8 – 10 , 13 – 15 , 19 ], was found to be higher than those in various subgroups, such as neurosurgical, burn, or cardiothoracic ICUs (from 7.9 to 8.3 cases per 10,000 patient-days or 0.5 to 0.6% of ICU population) [ 11 , 12 , 16 , 17 ]. Such variability may be related to differences in patient populations, underlying illness severities, comorbidities, or antibiotic use among different ICUs.…”

Section: Discussionmentioning

confidence: 99%

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

Lee¹,

Hung²,

Lin³

et al. 2016

PLoS ONE

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Critical patients are susceptible to Clostridium difficile infections (CDIs), which cause significant morbidity and mortality in the hospital. In Taiwan, the epidemiology of CDI in intensive care units (ICUs) is not well understood. This study was aimed to describe the incidence and the characteristics of CDI in the ICUs of a medical center in southern Taiwan. Adult patients with diarrhea but without colostomy/colectomy or laxative use were enrolled. Stool samples were collected with or without 5 ml alcohol and were plated on cycloserine-cefoxitin-fructose agar. C. difficile identification was confirmed by polymerase chain reaction. There were 1,551 patients admitted to ICUs, 1,488 screened, and 145 with diarrhea. A total of 75 patients were excluded due either to laxative use, a lack of stool samples, or refusal. Overall, 70 patients were included, and 14 (20%) were diagnosed with CDI, with an incidence of 8.8 cases per 10,000 patient-days. The incidence of CDI was found to be highest in March 2013 and lowest in the last quarter of 2013. The cases were categorized as the following: 5 severe, complicated, 5 severe, and 4 mild or moderate diseases. Among the 14 cases of CDI, the median patient age was 74 (range: 47–94) years, and the median time from admission to diarrhea onset was 16.5 (4–53) days. Eight cases received antimicrobial treatment (primarily metronidazole), and the time to diarrheal resolution was 11.5 days. Though 6 cases were left untreated, no patients died of CDI. The in-hospital mortality of CDI cases was 50%, similar to that of patients without CDI (46.4%; P = 1.0). We concluded that the overall incidence of CDI in our medical ICUs was low and there were variable seasonal incidences and disease severities of CDI.

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Clostridium difficile infections in patients with severe burns

Cited by 20 publications

References 16 publications

Hospital Ward Antibiotic Prescribing and the Risks ofClostridium difficileInfection

Hospital Ward Antibiotic Prescribing and the Risks ofClostridium difficileInfection

Clostridium difficile Associated Disease in a Neurointensive Care Unit

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

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