Natalia M Jasiak1, Cesar Alaniz1, Krishna Rao2, Katherine Veltman3, Jerod L Nagel4. 1. Department of Pharmacy Services, University of Michigan Health System, Ann Arbor, MI; College of Pharmacy, University of Michigan, Ann Arbor, MI. 2. Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI; Division of Infectious Diseases, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI. 3. College of Pharmacy, University of Michigan, Ann Arbor, MI. 4. Department of Pharmacy Services, University of Michigan Health System, Ann Arbor, MI; College of Pharmacy, University of Michigan, Ann Arbor, MI. Electronic address: nageljl@med.umich.edu.
Abstract
BACKGROUND: The purpose of this study was to assess the 12-week cumulative incidence of recurrent Clostridium difficile infection (rCDI) and identify risk factors for rCDI in patients that acquired index C difficile infection (CDI) while in the intensive care unit (ICU). METHODS: This retrospective single-center cohort study reviewed adult patients from 6 different ICUs who developed a CDI between February 2010 and September 2013. RESULTS: Out of 162 included ICU patients, 34 experienced rCDI. Risk of rCDI was higher in the ICU versus non-ICU group (21% vs 17%, P = .03). The incidence of rCDI was highest in the surgical intensive care unit (SICU) at 43.8%. A multivariable logistic regression model was constructed and identified 5 significant risk factors for rCDI: previous CDI (odds ratio [OR], 8.03; 95% confidence interval [CI], 1.90-34.02; P = .005), log10 ICU length of stay in days (OR, 3.67; 95% CI, 1.13-11.85; P = .03), acquisition of CDI in the medical intensive care unit (MICU) (OR, 5.35; 95% CI, 1.60-17.85; P = .006) or SICU (OR, 15.30; 95% CI, 4.09-57.23; P < .001), and chronic obstructive pulmonary disease (COPD) (OR, 3.55; 95% CI, 1.41-8.94; P = .007). CONCLUSION: ICU adults had a significantly higher 12-week incidence of rCDI than non-ICU patients. Risk factors for rCDI after acquisition of infection in an ICU include MICU and SICU patients, previous CDI, COPD, and length of stay.
BACKGROUND: The purpose of this study was to assess the 12-week cumulative incidence of recurrent Clostridium difficileinfection (rCDI) and identify risk factors for rCDI in patients that acquired index C difficile infection (CDI) while in the intensive care unit (ICU). METHODS: This retrospective single-center cohort study reviewed adult patients from 6 different ICUs who developed a CDI between February 2010 and September 2013. RESULTS: Out of 162 included ICU patients, 34 experienced rCDI. Risk of rCDI was higher in the ICU versus non-ICU group (21% vs 17%, P = .03). The incidence of rCDI was highest in the surgical intensive care unit (SICU) at 43.8%. A multivariable logistic regression model was constructed and identified 5 significant risk factors for rCDI: previous CDI (odds ratio [OR], 8.03; 95% confidence interval [CI], 1.90-34.02; P = .005), log10 ICU length of stay in days (OR, 3.67; 95% CI, 1.13-11.85; P = .03), acquisition of CDI in the medical intensive care unit (MICU) (OR, 5.35; 95% CI, 1.60-17.85; P = .006) or SICU (OR, 15.30; 95% CI, 4.09-57.23; P < .001), and chronic obstructive pulmonary disease (COPD) (OR, 3.55; 95% CI, 1.41-8.94; P = .007). CONCLUSION: ICU adults had a significantly higher 12-week incidence of rCDI than non-ICU patients. Risk factors for rCDI after acquisition of infection in an ICU include MICU and SICU patients, previous CDI, COPD, and length of stay.