Analysis of 30-Day Mortality for Clostridium difficile-Associated Disease in the ICU Setting

ObjectiveTo examine the 30-day mortality rate among patients with Clostridium difficile-associated disease (CDAD) requiring intensive care.DesignA retrospective, single-center, observational, cohort study.SettingBarnes-Jewish Hospital, a 1,200-bed, urban, teaching facility.PatientsAdult patients admitted to the ICU identified to have CDAD by enzyme immunoassay.InterventionsRetrospective data collection from automated hospital, microbiology, and pharmacy databases.Measurements and main resultsTwo hundred seventy-eight patients with CDAD admitted to an ICU were identified over a 2-year period. Two hundred six patients (74.1%) received prior antibiotic therapy. The overall 30-day mortality rate was 36.7% (n = 102). Logistic regression analysis identified septic shock (adjusted odds ratio, 1.96; 95% confidence interval [CI], 1.47 to 2.61; p = 0.018), ward-to-ICU transfer (adjusted odds ratio, 2.12; 95% CI, 1.62 to 2.79; p = 0.006), and increasing APACHE (acute physiology and chronic health evaluation) II scores (1-point increments) [adjusted odds ratio, 1.09; 95% CI, 1.07 to 1.12; p < 0.001] as independent predictors for 30-day mortality. The attributable mortality associated with CDAD was estimated to be 6.1% (95% CI, − 1.7 to 13.9%; p = 0.127). CDAD was associated with an excess ICU length of stay (2.2 days) and hospital length of stay (4.5 days).ConclusionsWe found a high 30-day crude mortality among patients with CDAD in the ICU setting. Although the attributable mortality from CDAD was relatively low, excess length of stay in the ICU and hospital was observed with CDAD. ICUs should routinely employ infection control efforts aimed at minimizing the occurrence of CDAD because of the excess morbidity associated with this nosocomial infection.