TY - JOUR
T1 - Clostridium difficile in the intensive care unit
T2 - Epidemiology, costs, and colonization pressure
AU - Lawrence, Steven J.
AU - Puzniak, Laura A.
AU - Shadel, Brooke N.
AU - Gillespie, Kathleen N.
AU - Kollef, Marin H.
AU - Mundy, Linda M.
PY - 2007/2
Y1 - 2007/2
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=33847766665&partnerID=8YFLogxK
U2 - 10.1086/511793
DO - 10.1086/511793
M3 - Article
C2 - 17265392
AN - SCOPUS:33847766665
SN - 0899-823X
VL - 28
SP - 123
EP - 130
JO - Infection Control and Hospital Epidemiology
JF - Infection Control and Hospital Epidemiology
IS - 2
ER -