C. difficile colonization associated with CDI development among patients in the ICU
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Patients in the ICU with Clostridioides difficile colonization, histories of inflammatory bowel disease and longer ICU stays had an increased risk for developing C. difficile infection, according to a study in Infection Control & Hospital Epidemiology.
“We know that colonization with Clostridioides difficile amongst hospitalized patients in general confers a greater risk of developing C. difficile infection, but there [are] not a lot of data about colonization in ICU patients,” Erica L. MacKenzie, MD, of the University of Chicago Medicine’s department of medicine, told Healio.
“Patients in the ICU have high rates of morbidity and mortality related to C. difficile infection (CDI), so they are an important population to study,” she said.
MacKenzie and colleagues performed a retrospective observational cohort study among adult patients admitted to an ICU between July 1, 2015, and Nov. 6, 2019, who were tested for C. difficile colonization and did not have CDI to determine risk factors for C. difficile colonization and CDI.
The researchers collected information on patient demographics, comorbidities, laboratory results and prescriptions, and analyzed it with the primary outcome measure as the development of CDI up to 30 days after ICU admission.
The study showed that the overall C. difficile colonization rate was 4%, whereas the overall CDI rate was 2%.
The researchers determined that risk factors for the development of CDI included C. difficile colonization (adjusted OR = 13.3; 95% CI, 8.3-21.3), increased length of stay in the ICU by more than 2 days (aOR = 1.04; 95% CI, 1.03-1.05) and a history of inflammatory bowel disease (aOR = 3.8; 95% CI, 1.3-11.1). Among those who developed CDI while in the ICU (43.4%), the median time to onset was 8 days after ICU admission.
They also found that patients who developed CDI were more likely to have received an antibiotic while in the ICU (86.9% vs 75.3%), particularly cephalosporin, although receipt of any antibiotic during the ICU stay was associated with a borderline increased odds of CDI (aOR = 1.9; 95% CI, 1-3.4).
“C. difficile colonization is highly associated with the development of C. difficile infection amongst ICU patients,” MacKenzie said. “Clinicians should consider this when making therapeutic decisions for these patients and when developing antimicrobial stewardship and infection control policies in the ICU.”
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MacKenzie EL, et al. Infect Control Hosp Epidemiol. 2023;doi:10.1017/ice.2022.240.
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