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Clostridium difficile in the Intensive Care Unit: Epidemiology, Costs, and Colonization Pressure

Published online by Cambridge University Press:  02 January 2015

Steven J. Lawrence ,
Laura A. Puzniak ,
Brooke N. Shadel ,
Kathleen N. Gillespie ,
Marin H. Kollef  and
Linda M. Mundy
Steven J. Lawrence*
Affiliation:
Divisions of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
Laura A. Puzniak
Affiliation:
Battelle Center of Public Health Research and Evaluation, St. Louis, Missouri
Brooke N. Shadel
Affiliation:
School of Public Health, Saint Louis University, St. Louis, Missouri
Kathleen N. Gillespie
Affiliation:
School of Public Health, Saint Louis University, St. Louis, Missouri
Marin H. Kollef
Affiliation:
Pulmonology/Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri
Linda M. Mundy
Affiliation:
School of Public Health, Saint Louis University, St. Louis, Missouri
*
Washington University School of Medicine, Box 8051, 660 South Euclid Avenue, St. Louis, MO 63110 (slawrenc@im.wustl.edu)
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Abstract

Objective.

To evaluate the epidemiology, outcomes, and importance of Clostridium difficile colonization pressure (CCP) as a risk factor for C. difficile–associated disease (CDAD) acquisition in intensive care unit (ICU) patients.

Design.

Secondary analysis of data from a 30-month retrospective cohort study.

Setting.

A 19-bed medical ICU in a midwestern tertiary care referral center.

Patients.

Consecutive sample of adult patients with a length of stay of 24 hours or more between July 1, 1997, and December 31, 1999.

Results.

Seventy-six (4%) of 1,872 patients were identified with CDAD; 40 (53%) acquired CDAD in the ICU, for an incidence of 3.2 cases per 1,000 patient-days. Antimicrobial therapy, enteral feeding, mechanical ventilation, vancomycin-resistant enterococci (VRE) colonization or infection, and CCP (5.5 vs 2.0 CDAD case-days of exposure for patients with acquired CDAD vs no CDAD; P = .001) were associated with CDAD acquisition in the univariate analysis. Only VRE colonization or infection (45% of patients with acquired CDAD vs 16% of patients without CDAD; adjusted odds ratio, 2.76 [95% confidence interval, 1.36-5.59]) and a CCP of more than 30 case-days of exposure (20% with acquired CDAD vs 2% with no CDAD; adjusted odds ratio, 3.77 [95% confidence interval, 1.14-12.49]) remained statistically significant in the multivariable analysis. Lengths of stay (6.1 vs 3.0 days; P < .001 by univariate analysis) and ICU costs ($11,353 vs $6,028; P < .001 by univariate analysis) were higher for patients with any CDAD than for patients with no CDAD.

Conclusions.

In this nonoutbreak setting, the CCP was an independent risk factor for acquisition of CDAD in the ICU at the upper range of exposure duration. Having CDAD in the ICU was a marker of excess healthcare use.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 2 , February 2007 , pp. 123 - 130
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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