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ICU setting associated with higher CDI rate
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The ICU setting was associated with an increased prevalence of Clostridium difficile infection, which in turn increased hospital mortality and overall length of stay, according to study data published in Open Forum Infectious Diseases.
Researchers said the findings underscore the need for additional prevention and treatment studies in the ICU setting.
Styliani Karanika
“Patients in ICUs are at particularly high risk for CDI due to presence of multiple risk factors, and CDI is the most common infectious cause of diarrhea in this setting,” Styliani Karanika, MD, a postdoctoral research associate at the Warren Alpert Medical School at Brown University, and colleagues wrote. “Although it has been estimated that 0.9% of the general hospital suffers from CDI, aggregate data on CDI rates among ICU patients are scarce.”
To determine the prevalence and clinical outcomes of CDI in ICU patients, the researchers conducted a systematic review and meta-analysis of published studies from 1983 to 2015, using PubMed, EMBASE and Google Scholar databases. Twenty-two studies, culled from 9,146 articles reporting cases of CDI among ICU populations, were included in the final analysis, with more than 80,000 ICU patients.
According to the researchers, the prevalence of CDI was 2% (95% CI, 1%-2%), with a prevalence of 11% (95% CI, 6%-11%) among diarrheic ICU patients. Among those with CDI, 25% (95% CI, 5%-51%) had been diagnosed with pseudomembranous colitis, and the estimated length of ICU stay before CDI acquisition was 10.74 days (95% CI, 8.04-13.44). The overall hospital mortality rate among ICU patients with CDI was 32% (95% CI, 26%-39%) vs. 24% (95% CI, 14%-36%) among those without the infection. In addition, the average ICU length of stay among patients with CDI was 23.54 days (95% CI, 19.19-27.9), compared with 19.16 days (95% CI, 6.06-31.46) for the non-CDI group. Overall hospital length of stay for patients with CDI was 49.58 days (95% CI, 40.99-58.16), while the average stay for patients without CDI was 29.9 days (95% CI, 22.82-36.99). The morbidity score at ICU admission — measured by APACHE II — was not statistically different between the groups.
“More than 1 out of 10 cases with diarrhea suffer from CDI and, subsequently, CDI affects adversely multiple clinical outcomes, such as the hospital mortality rate and length of stay,” Karanika and colleagues wrote. “These findings highlight the need for strict implementation of preventive policies in the critical care setting. Studies are needed to identify interventions, such as infection control measures and antibiotic stewardship programs, which may reduce the incidence and severity of CDI in this patient population.” – by Jason Laday
Disclosure: The researchers report no relevant financial disclosures.
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