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Critical Care |

Epidemiology of Clostridium difficile Infection Screening and Incident Cases in the Intensive Care Unit

Kelly Cawcutt; Rahul Kashyap; Gregory Wilson; Rodrigo Cartin-Ceba; Larry Baddour
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Mayo Clinic, Rochester, MN


Chest. 2014;146(4_MeetingAbstracts):219A. doi:10.1378/chest.1993958
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Abstract

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 infection (CDI) is the most common cause of infectious diarrhea in the intensive care unit (ICU) and has increased in incidence and severity over the past decade. To gain a better understanding of the epidemiology of CDI screening and disease in patients admitted to an ICU, a retrospective cohort study was completed at a single tertiary care center.

METHODS: The study included adult patients with pre-existing research authorization who were admitted to the intensive care unit from July 2, 2007 through September 30, 2012. Charts of all patients meeting inclusion criteria were screened for polymerase chain reaction (PCR) testing for Clostridium difficile.

RESULTS: There were a total of 69, 544 adult ICU admissions, 5365 PCRs completed with 532 (9.92%) positive. The medical ICU had the highest rates of both PCR screening and positive test results per thousand patient admissions at rates of 125.2 and 15.4, respectively. The Neurology ICU had the lowest overall rates at 32.2 and 2.7, respectively. Inclusion of all ICUs demonstrated a median 10.7- fold difference in the rate of screening as compared to the rate of positive PCR results (Interquartile range of 8.45 - 12.2; mean 11.2). Of the 532 positive PCRs, only 207 (38.9%) patients had an initial positive PCR >= 48 hours after ICU admission. 17 patients were excluded due to direct transfer from an outside hospital, resulting in a final total of 190 incident CDI cases in the ICU. The majority of cases were documented in the medical ICU and trauma surgery ICU, with 43 cases each. The median age of patients was 66.8 years (interquartile range 54.9, 78.7; mean 64.9). Sex was distributed fairly evenly with 55% male, 45% female. The median time between ICU admission and PCR testing was 5.0 days (interquartile range 3.3, 9.0). ICU length of stay was a median of 10.8 days (interquartile range 5.6, 19.4) with a median hospital length of stay of 23.9 days (interquartile range 13.4, 43.3).

CONCLUSIONS: This study demonstrated an approximate 11-fold difference in rate of screening versus positive test results for CDI among adult patients admitted to intensive care units at a single center.

CLINICAL IMPLICATIONS: Considering the high prevalence of diarrhea in the ICU, and the approximate 11-fold difference in rate of screening versus positive test results, management algorithms need to be developed to reduce infection rates and enhance laboratory screening rates.

DISCLOSURE: The following authors have nothing to disclose: Kelly Cawcutt, Rahul Kashyap, Gregory Wilson, Rodrigo Cartin-Ceba, Larry Baddour

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