Investigation of critical care unit utilization and mortality in patients infected with Clostridium difficile

James Gasperino, Maya Garala, Hillel W. Cohen, Vladimir Kvetan, Brian Currie

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: A nationwide increase in the rate and severity of Clostridium difficile-associated disease may reflect infection with a virulent strain characterized by polymerase chain reaction as ribotype 027 (NAP1/B1). Hypothesis: The high prevalence of ribotype 027 at our institution would allow investigation of the risk of mortality and admission to the intensive care unit (ICU) associated with C difficile infection. Methods: In a retrospective cohort study, we identified 108 patients with positive enzyme-linked immunosorbant assay tests for C difficile toxins over a 6-month period and compared them to 108 patients who were suspected to have C difficile but with negative toxin assays. Proportions of all-cause mortality and ICU admission were compared using χ2, and odds ratios (ORs) were estimated using logistic regression to adjust for potential confounders. Mean log lengths of stay were compared using t test. Results: Comparing patients with C difficile to those without, mortality (20% vs 8%) and ICU admission (32% vs 17%) were significantly higher (P = .02 for both), whereas log length of stay was not (P = .29). Adjusting for potential confounders, the OR for mortality was 6.8 (95% confidence interval, 1.8-25.4; P = .01), whereas for ICU admission, the association was no longer observed (OR, 1.0; 95% confidence interval, 0.4-2.5; P = .97). Conclusion: C difficile infection was associated with increased all-cause mortality. An observed association with ICU admission and C difficile infection was identified through univariate analysis but was not significant in multivariate analysis. Although we did not strain-type isolates for patients infected with C difficile, the institutional prevalence of ribotype 027 C difficile infection was known to be high. These results document a strong association between ribotype 027 C difficile infection and mortality and underscore the need to identify effective C difficile preventive strategies.

Original languageEnglish (US)
Pages (from-to)282-286
Number of pages5
JournalJournal of Critical Care
Volume25
Issue number2
DOIs
StatePublished - Jun 2010

Fingerprint

Clostridium difficile
Critical Care
Ribotyping
Intensive Care Units
Mortality
Infection
Odds Ratio
Length of Stay
Confidence Intervals
Cohort Studies
Multivariate Analysis
Retrospective Studies
Logistic Models
Polymerase Chain Reaction
Enzymes

Keywords

  • C difficile
  • Intensive care
  • Mortality

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Investigation of critical care unit utilization and mortality in patients infected with Clostridium difficile. / Gasperino, James; Garala, Maya; Cohen, Hillel W.; Kvetan, Vladimir; Currie, Brian.

In: Journal of Critical Care, Vol. 25, No. 2, 06.2010, p. 282-286.

Research output: Contribution to journalArticle

Gasperino, James ; Garala, Maya ; Cohen, Hillel W. ; Kvetan, Vladimir ; Currie, Brian. / Investigation of critical care unit utilization and mortality in patients infected with Clostridium difficile. In: Journal of Critical Care. 2010 ; Vol. 25, No. 2. pp. 282-286.
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abstract = "Background: A nationwide increase in the rate and severity of Clostridium difficile-associated disease may reflect infection with a virulent strain characterized by polymerase chain reaction as ribotype 027 (NAP1/B1). Hypothesis: The high prevalence of ribotype 027 at our institution would allow investigation of the risk of mortality and admission to the intensive care unit (ICU) associated with C difficile infection. Methods: In a retrospective cohort study, we identified 108 patients with positive enzyme-linked immunosorbant assay tests for C difficile toxins over a 6-month period and compared them to 108 patients who were suspected to have C difficile but with negative toxin assays. Proportions of all-cause mortality and ICU admission were compared using χ2, and odds ratios (ORs) were estimated using logistic regression to adjust for potential confounders. Mean log lengths of stay were compared using t test. Results: Comparing patients with C difficile to those without, mortality (20{\%} vs 8{\%}) and ICU admission (32{\%} vs 17{\%}) were significantly higher (P = .02 for both), whereas log length of stay was not (P = .29). Adjusting for potential confounders, the OR for mortality was 6.8 (95{\%} confidence interval, 1.8-25.4; P = .01), whereas for ICU admission, the association was no longer observed (OR, 1.0; 95{\%} confidence interval, 0.4-2.5; P = .97). Conclusion: C difficile infection was associated with increased all-cause mortality. An observed association with ICU admission and C difficile infection was identified through univariate analysis but was not significant in multivariate analysis. Although we did not strain-type isolates for patients infected with C difficile, the institutional prevalence of ribotype 027 C difficile infection was known to be high. These results document a strong association between ribotype 027 C difficile infection and mortality and underscore the need to identify effective C difficile preventive strategies.",
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