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Clostridium difficile Infection: A Multicenter Study of Epidemiology and Outcomes in Mechanically Ventilated Patients

Micek, Scott T. PharmD1,2; Schramm, Garrett PharmD3; Morrow, Lee MD4; Frazee, Erin PharmD3; Personett, Heather PharmD3; Doherty, Joshua A. BA5; Hampton, Nicholas PharmD5; Hoban, Alex BS6; Lieu, Angela7; McKenzie, Matthew2; Dubberke, Erik R. MD8; Kollef, Marin H. MD6

doi: 10.1097/CCM.0b013e31828a40d5
Clinical Investigations

Objectives: Clostridium difficile is a leading cause of hospital-associated infection in the United States. The purpose of this study is to assess the prevalence of C. difficile infection among mechanically ventilated patients within the ICUs of three academic hospitals and secondarily describe the influence of C. difficile infection on the outcomes of these patients.

Design: A retrospective cohort study.

Setting: ICUs at three teaching hospitals: Barnes-Jewish Hospital, Mayo Clinic, and Creighton University Medical Center over a 2-year period.

Patients: All hospitalized patients requiring mechanical ventilation for greater than 48 hours within an ICU were eligible for inclusion.

Interventions: None.

Measurements and Main Results: A total of 5,852 consecutive patients admitted to the ICU were included. Three hundred eighty-six (6.6%) patients with development of C. difficile infection while in the hospital (5.39 cases/1,000 patient days). Septic shock complicating C. difficile infection occurred in 34.7% of patients. Compared with patients without C. difficile infection (n = 5,466), patients with C. difficile infection had a similar hospital mortality rate (25.1% vs 26.3%, p = 0.638). Patients with C. difficile infection were significantly more likely to be discharged to a skilled nursing or rehabilitation facility (42.4% vs 31.9%, p < 0.001), and the median hospital (23 d vs 15 d, p < 0.001) and ICU length of stay (12 d vs 8 d, p < 0.001) were found to be significantly longer in patients with C. difficile infection.

Conclusions: Clostridium difficile infection is a relatively common nosocomial infection in mechanically ventilated patients and is associated with prolonged length of hospital and ICU stay, and increased need for skilled nursing care or rehabilitation following hospital discharge.

1Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, MO.

2St. Louis College of Pharmacy, St. Louis, MO.

3Pharmacy Services, Mayo Clinic, Rochester, MN.

4Division of Pulmonary, Critical Care, and Sleep Medicine, Creighton University School of Medicine, Omaha, NE.

5Center for Clinical Excellence, BJC Healthcare, St. Louis, MO.

6Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO.

7Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ.

8Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO.

Drs. Micek, Dubberke, and Kollef had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs. Micek and Kollef contributed to the study conception and design, statistical analysis, and critical revision of the article. Drs. Schramm, Morrow, Frazee, and Personett, Mr. Doherty, Dr. Hampton, Mr. Hoban, Ms. Lieu, and Mr. McKenzie contributed to acquisition of the data and critical revision for important intellectual content.

Supported, in part, by an unrestricted grant from Optimer Pharmaceuticals Inc. The sponsor had no role in any aspect of this investigation to include study conception and design, statistical analysis, and critical revision of the article.

Dr. Dubberke is a consultant for Optimer, Merck, Pfizer, Sanofi Pasteur and Micrbex. He has received grant support from Merck, Optimer, and Sanofi Pasteur. Dr. Kollef’s efforts were supported by the Barnes-Jewish Hospital Foundation. Dr. Kollef is a consultant for Optimer. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins