Clostridioides difficile infections in the intensive care unit: a monocentric cohort study
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ORIGINAL PAPER
Clostridioides difficile infections in the intensive care unit: a monocentric cohort study Rebeca Cruz Aguilar1 · Jon Salmanton‑García1 · Jonathan Carney2 · Boris Böll1,5 · Matthias Kochanek1,5 · Nathalie Jazmati6,7 · Oliver A. Cornely1,3,4,5,8,9 · Maria J. G. T. Vehreschild1,2,3 Received: 31 October 2019 / Accepted: 11 March 2020 © The Author(s) 2020
Abstract Introduction Patient-level data from Clostridioides difficile infections (CDI) treated in an intensive care setting is limited, despite the growing medical and financial burden of CDI. Methods We retrospectively analyzed data from 100 medical intensive care unit patients at the University Hospital Cologne with respect to demography, diagnostics, severity scores, treatment, and outcome. To analyze factors influencing response to treatment and death, a backward-stepwise multiple logistic regression model was applied. Results Patients had significant comorbidities including 26% being immunocompromised. The mean Charlson Comorbidity Index was 6.3 (10-year survival rate of 2.25%). At the time of diagnosis, the APACHE II was 17.4±6.3 (predicted mortality rate of 25%), and the ATLAS score was 5.2±1.9 (predicted cure rate of 75%). Overall, 47% of CDI cases were severe, 35% were complicated, and 23% were both. At least one concomitant antibiotic was given to 74% of patients. The cure rate after 10 and 90 days was 56% and 51%, respectively. Each unit increment in APACHE II score was associated with poorer treatment response (OR 0.931; 95% CI 0.872–0.995; p = 0.034). Age above 65 years was associated with death (OR 2.533; 95% CI 1.031–6.221; p = 0.043), and overall mortality at 90 days was 56%. Conclusions CDI affects a high-risk population, in whom predictive scoring tools are not accurate, and outcomes are poor despite intensive treatment. Further research in this field is warranted to improve prediction scoring and patient outcomes. Keywords Clostridioides difficile · Intensive care · Diarrhea · Morbidity · Mortality
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Electronic supplementary material The online version of this article (https://doi.org/10.1007/s15010-020-01413-8) contains supplementary material, which is available to authorized users. * Maria J. G. T. Vehreschild [email protected] 1
Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
2
Department of Internal Medicine, Zentrum für Innere Medizin, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
3
German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
4
Cologne Excellence Cluster on Cellular Stress Responses in Aging‑Associated Diseases (CECAD), University of Cologne, Cologne, Germany
Clostridioides difficile, a ubiquitous Gram-positive, sporeforming anaerobic bacillus, remains the leading cause of health-care-associated infectious diarrhea in hospitalized 5
Center for Integrated Oncology CIO Köln/Bonn, Medical Faculty
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