1. Outcome of ICU patients with Clostridium difficile infection
- Author
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Kevin B. Laupland, Molière Nguile-Makao, Aurélien Vesin, Alexis Tabah, Maité Garrouste-Orgeas, Christophe Adrie, Carole Schwebel, Jean-François Timsit, Adrien Français, Jean-Ralph Zahar, Alban Le-Monnier, Institut d'oncologie/développement Albert Bonniot de Grenoble (INSERM U823), Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de bactériologie, virologie, parasitologie et hygiène [CHU Necker], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Clinique de réanimation médicale, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, Service de réanimation médicale et chirurgicale, Hôpital Delafontaine, Service de soins intensifs, Hôpital Saint-Joseph, Critical Care Medicine, University of Calgary-Peter Lougheed Centre, Département de microbiologie, Centre Hospitalier de Versailles André Mignot (CHV), Écosystème Microbien Digestif et Santé, Institut National de la Recherche Agronomique (INRA)-Université Paris-Sud - Paris 11 (UP11), INSERM U823, équipe 11 (Epidémiologie des cancers et des affections graves), Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM)-Clinique de réanimation médicale, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon-Hôpital Michallon-Service de réanimation médicale et chirurgicale, Hôpital Delafontaine-Hôpital Delafontaine, OUTCOMEREA study group, BMC, Ed., Service de bactériologie, virologie, parasitologie et hygiène, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Necker - Enfants Malades [AP-HP], Hôpital André Mignot, Institut National de la Santé et de la Recherche Médicale (INSERM)-EFS-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF), and Institut National de la Santé et de la Recherche Médicale (INSERM)-EFS-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM)-EFS-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF)-Clinique de réanimation médicale
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SELECTION ,medicine.medical_specialty ,Pediatrics ,STRAIN ,INTENSIVE-CARE-UNIT ,IMPACT ,[SDV.MHEP.PHY] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO] ,Population ,MODELS ,Critical Care and Intensive Care Medicine ,DISEASE ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,ORGAN DYSFUNCTION ,law ,EPIDEMIC ,Internal medicine ,medicine ,[SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO] ,030212 general & internal medicine ,education ,education.field_of_study ,business.industry ,MORTALITY ,Research ,030208 emergency & critical care medicine ,Pseudomembranous colitis ,Clostridium difficile ,Intensive care unit ,DIARRHEA ,Confidence interval ,3. Good health ,Diarrhea ,Metronidazole ,Quartile ,medicine.symptom ,business ,medicine.drug - Abstract
Group Authors : OUTCOMEREA Study Grp; International audience; ABSTRACT: INTRODUCTION: As data from Clostridium difficile infection (CDI) in intensive care unit (ICU) are still scarce, our objectives were to assess the morbidity and mortality of ICU-acquired CDI. METHODS: We compared patients with ICU-acquired CDI (watery or unformed stools occurring ≥ 72 hours after ICU admission with a stool sample positive for C. difficile toxin A or B) with two groups of controls hospitalized at the same time in the same unit. The first control group comprised patients with ICU-acquired diarrhea occurring ≥ 72 hours after ICU admission with a stool sample negative for C. difficile and for toxin A or B. The second group comprised patients without any diarrhea. RESULTS: Among 5,260 patients, 512 patients developed one episode of diarrhea. Among them, 69 (13.5%) had a CDI; 10 (14.5%) of them were community-acquired, contrasting with 12 (17.4%) that were hospital-acquired and 47 (68%) that were ICU-acquired. A pseudomembranous colitis was associated in 24/47 (51%) ICU patients. The median delay between diagnosis and metronidazole administration was one day (25th Quartile; 75th Quartile (0; 2) days). The case-fatality rate for patients with ICU-acquired CDI was 10/47 (21.5%), as compared to 112/443 (25.3%) for patients with negative tests. Neither the crude mortality (cause specific hazard ratio; CSHR = 0.70, 95% confidence interval; CI 0.36 to 1.35, P = 0.3) nor the adjusted mortality to confounding variables (CSHR = 0.81, 95% CI 0.4 to 1.64, P = 0.6) were significantly different between CDI patients and diarrheic patients without CDI. Compared to the general ICU population, neither the crude mortality (SHR = 0.64, 95% CI 0.34 to 1.21, P = 0.17), nor the mortality adjusted to confounding variables (CSHR = 0.71, 95% confidence interval (CI) 0.38 to 1.35, P = 0.3), were significantly different between the two groups. The estimated increase in the duration of stay due to CDI was 8.0 days ± 9.3 days, (P = 0.4) in comparison to the diarrheic population, and 6.3 days ± 4.3 (P = 0.14) in comparison to the general ICU population. CONCLUSIONS: If treated early, ICU-acquired CDI is not independently associated with an increased mortality and impacts marginally the ICU length of stay.
- Published
- 2012