SESSION TITLE: ICU Infections
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Monday, October 27, 2014 at 01:30 PM - 02:30 PM
PURPOSE: Clostridium-difficile-Associated-Diarrhea (CDAD) has been increasing in incidence with limited data on possible risk factors for recurrence.
METHODS: This IRB-approved retrospective study included 3010 patients (pts), out of which 2019 were admitted between 1/2007 and 11/2013 and had adequate follow up. CDAD was defined as >3 episodes of loose stools in <24 h with a positive Clostridium difficile stool toxin assay. Recurrence was defined as a 2nd positive stool test within 90 days following complete resolution of previous diarrheal episode and cessation of treatment comprising a ten-day period. Severe CDAD was suggested by WBC >15,000 cells/microL or a serum creatinine level ≥1.5 times with a correlated clinical picture. Pts medical records were reviewed for demographics, hospital length of stay, laboratory blood work, co-morbidities, medication used, presenting complaint and CDAD treatment. Recurrence of CDAD was sub-analyzed based on each comorbid condition, medication and treatment given (vancomycin, metronidazole, fidaxomicin or any combination).
RESULTS: 2019 patients were diagnosed with CDAD, 798 males, average age 67 and average length of hospital stay was 10 days. 233 pts had severe CDAD, 51 pts with malignancy. 268 recurrences identified in the study population. In univariate line regression, definitive correlation exists between recurrence and PPI and steroid however, other parameters of the cohort were mostly non significant, including age (p=0.2478), male gender (p=0.368), length of hospital stay (p=0.899). In multivariate analysis using Cox regression, adjusting for age, sex, length of hospital stay and treatment used, there was definitive correlation between patients with PPI (P=0.0331), steroid (P=0.0305) and recurrence of CDAD.
CONCLUSIONS: PPI, steroids and Clostridium-difficile pharmacological agent used in treatment had statistically significant effect on recurrence of CDAD.
CLINICAL IMPLICATIONS: CDAD is one of the most common and serious complications in intensive care units, Intensivists should watch for recurrence in patients on PPI or steroids.
DISCLOSURE: The following authors have nothing to disclose: Mohamed Abdelfatah, Rabih Nayfe, Ala Nijim, Kathleen Enriquez, Richard Watkins
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