• Alexandre R Marra, Michael B Edmond, Richard P Wenzel, and Gonzalo M L Bearman.
• Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil. a.marra@uol.com.br
• Bmc Infect Dis. 2007 Jan 1;7:42.

BackgroundClostridium difficile-associated disease (CDAD) is a serious nosocomial infection, however few studies have assessed CDAD outcome in the intensive care unit (ICU). We evaluated the epidemiology, clinical course and outcome of hospital-acquired CDAD in the critical care setting.MethodsWe performed a historical cohort study on 58 adults with a positive C. difficile cytotoxin assay result occurring in intensive care units.ResultsSixty-two percent of patients had concurrent infections, 50% of which were bloodstream infections. The most frequently prescribed antimicrobials prior to CDAD were anti-anaerobic agents (60.3%). Septic shock occurred in 32.8% of CDAD patients. The in-hospital mortality was 27.6%. Univariate analysis revealed that SOFA score, at least one organ failure and age were predictors of mortality. Charlson score >/=3, gender, concurrent infection, and number of days with diarrhea before a positive C. difficile toxin assay were not significant predictors of mortality on univariate analysis. Independent predictors for death were SOFA score at infection onset (per 1-point increment, OR 1.40; CI95 1.13-1.75) and age (per 1-year increment, OR 1.10; CI95 1.02-1.19).ConclusionIn ICU patients with CDAD, advanced age and increased severity of illness at the onset of infection, as measured by the SOFA score, are independent predictors of death.

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