Clostridium difficile –Associated Disease Acquired in the Cardiothoracic Intensive Care Unit

• Published in: Journal of cardiothoracic and vascular anesthesia Vol. 25; no. 2; pp. 263 - 267
• Main Authors: Musa, Saif A., BSc, MRCP, Moran, Carl, MRCP, Thomson, Sam J., MRCP, Cowan, Matthew L., BSc, MRCP, McAnulty, Greg, FRCA, Grounds, Michael, MD, FRCA, Rahman, Tony Manibur, MA, PhD, FRCP
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2011
• Subjects: Aged; Anesthesia & Perioperative Care; cardiac care facilities; Clostridium difficile; Clostridium difficile - isolation & purification; Clostridium difficile–associated disease; Coronary Care Units - standards; Critical Care; Cross Infection - diagnosis; Cross Infection - epidemiology; Cross Infection - etiology; Enterocolitis, Pseudomembranous - diagnosis; Enterocolitis, Pseudomembranous - epidemiology; Enterocolitis, Pseudomembranous - etiology; Female; Humans; Intensive Care Units - standards; Male; Retrospective Studies; Risk Factors; critical care; cardiac care facilities; Clostridium difficile–associated disease; Clostridium difficile
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2010.05.004

Objectives To determine the prevalence, severity, and outcome associated with Clostridium difficile –associated disease (CDAD) acquired while in the cardiothoracic intensive care unit (CTICU). Design A 5-year retrospective study. Setting The CTICU. Participants All CTICU patients with a positive C difficile stool toxin assay 48 hours after admission. Interventions None. Measurements and Main Results The results of all CTICU patients with a positive C difficile stool toxin assay were obtained from the Microbiology Department. Each patient's medical notes and charts then were reviewed in turn. A total of 27 of 5,199 (0.5%) CTICU patients acquired CDAD. The median age was 74 years (IQR 68-77), and 17 (63%) patients were male. There were 21 (78%) surgical patients; 13 (62%) were elective admissions. The most frequent diagnosis on admission was valvular heart disease (10 [37%] patients). Sixteen (59%) patients underwent coronary artery bypass graft (CABG) surgery and/or valvular heart surgery. The median interval between CTICU admission and CDAD diagnosis was 10 days (IQR 5-18). Previously identified risk factors for ICU-acquired CDAD included age >65 years (23), antibiotic use (26), and medical device requirements (27). At the time of diagnosis, 14 (52%) patients had moderate CDAD. After treatment initiation, 8 (30%) patients developed worsening CDAD. The 30-day in-hospital mortality rate for CTICU-acquired CDAD was 26% (7 patients). Conclusions C difficile –associated disease rarely is acquired in the CTICU. Approximately one third of patients may experience disease progression, and just over a quarter may die within 30 days of diagnosis. The implementation of recommended severity definitions and treatment algorithms may reduce complication rates and merits prospective evaluation.