Chest
Volume 132, Issue 2, August 2007, Pages 418-424
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Original Research
Critical Care Medicine
Analysis of 30-Day Mortality for Clostridium difficile-Associated Disease in the ICU Setting

https://doi.org/10.1378/chest.07-0202Get rights and content

Objective

To examine the 30-day mortality rate among patients with Clostridium difficile-associated disease (CDAD) requiring intensive care.

Design

A retrospective, single-center, observational, cohort study.

Setting

Barnes-Jewish Hospital, a 1,200-bed, urban, teaching facility.

Patients

Adult patients admitted to the ICU identified to have CDAD by enzyme immunoassay.

Interventions

Retrospective data collection from automated hospital, microbiology, and pharmacy databases.

Measurements and main results

Two hundred seventy-eight patients with CDAD admitted to an ICU were identified over a 2-year period. Two hundred six patients (74.1%) received prior antibiotic therapy. The overall 30-day mortality rate was 36.7% (n = 102). Logistic regression analysis identified septic shock (adjusted odds ratio, 1.96; 95% confidence interval [CI], 1.47 to 2.61; p = 0.018), ward-to-ICU transfer (adjusted odds ratio, 2.12; 95% CI, 1.62 to 2.79; p = 0.006), and increasing APACHE (acute physiology and chronic health evaluation) II scores (1-point increments) [adjusted odds ratio, 1.09; 95% CI, 1.07 to 1.12; p < 0.001] as independent predictors for 30-day mortality. The attributable mortality associated with CDAD was estimated to be 6.1% (95% CI, − 1.7 to 13.9%; p = 0.127). CDAD was associated with an excess ICU length of stay (2.2 days) and hospital length of stay (4.5 days).

Conclusions

We found a high 30-day crude mortality among patients with CDAD in the ICU setting. Although the attributable mortality from CDAD was relatively low, excess length of stay in the ICU and hospital was observed with CDAD. ICUs should routinely employ infection control efforts aimed at minimizing the occurrence of CDAD because of the excess morbidity associated with this nosocomial infection.

Section snippets

Study Location and Patients

This study was conducted at a university-affiliated, urban, teaching hospital: Barnes-Jewish Hospital (1,200 beds). During a 2-year period (January 2004 to December 2005), all patients in an ICU (medical, surgical, neurosurgical, cardiac, and cardiothoracic surgery) with a diagnosis of CDAD were eligible for this investigation. Patients with CDAD transferred to an ICU from another hospital, patients with a do-not-resuscitate order in their medical records, and those with a previous diagnosis of

Patients

A total of 289 consecutive patients with CDAD were initially evaluated. Eleven patients were excluded because of prior hospitalization for CDAD. The remaining 278 patients constituted the study cohort; of whom 102 patients (36.7%) died within 30 days of the diagnosis of CDAD. The mean age of the study patients was 63.9 ± 15.9 years (range, 17 to 96 years), and the average APACHE II score was 20.4 ± 6.4 (range, 5 to 38). There were 148 men (53.2%) and 130 women (46.8%); 196 patients (70.5%) were

Discussion

We observed a crude 30-day mortality rate of 36.7% for patients with CDAD in the ICU setting. We also identified potential risk factors for 30-day mortality among critically ill patients with CDAD, including greater severity of illness, the presence of septic shock, and having CDAD develop on the hospital ward prior to ICU transfer. CDAD was associated with a 6.1% attributable mortality rate and prolonged lengths of stay in the ICU and hospital. These findings suggest that mortality due to CDAD

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    The authors have no conflicts of interest to report for this work.

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