Clostridioides difficile infection in mechanically ventilated critically ill patients: A nested cohort study

Joanna C Dionne; Jennie Johnstone; Diane Heels-Ansdell; Erick Duan; Francois Lauzier; Yaseen M Arabi; Neill K J Adhikari; Wendy Sligl; Peter Dodek; Bram Rochwerg; John C Marshall; Daniel J Niven; David R Williamson; Steven Reynolds; Nicole Zytaruk; Deborah Cook

doi:10.1016/j.jcrc.2023.154254

Clostridioides difficile infection in mechanically ventilated critically ill patients: A nested cohort study

J Crit Care. 2023 Jun:75:154254. doi: 10.1016/j.jcrc.2023.154254. Epub 2023 Jan 20.

Authors

Joanna C Dionne¹, Jennie Johnstone², Diane Heels-Ansdell³, Erick Duan⁴, Francois Lauzier⁵, Yaseen M Arabi⁶, Neill K J Adhikari⁷, Wendy Sligl⁸, Peter Dodek⁹, Bram Rochwerg¹⁰, John C Marshall¹¹, Daniel J Niven¹², David R Williamson¹³, Steven Reynolds¹⁴, Nicole Zytaruk³, Deborah Cook¹⁰

Affiliations

¹ Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Farncombe Family Digestive Health Research Institute, McMaster University Hamilton, Ontario, Canada; Department of Health Research Methods, Evaluation and Impact, McMaster University, Canada. Electronic address: Joanna.dionne@medportal.ca.
² Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada.
³ Department of Health Research Methods, Evaluation and Impact, McMaster University, Canada.
⁴ Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
⁵ Department of Critical Care Medicine, Universite Laval, Quebec City, Quebec, Canada.
⁶ Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
⁷ Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Interdepartmental Division of Critical Care Medicine, University of Toronto, Canada.
⁸ Departments of Critical Care Medicine and Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada.
⁹ Division of Critical Care Medicine and Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
¹⁰ Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evaluation and Impact, McMaster University, Canada.
¹¹ Department of Surgery, Keenan Research Centre for Biomedical Research, University of Toronto, Toronto, Ontario, Canada.
¹² Departments of Critical Care Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
¹³ Pharmacy Department, Hôpital du Sacré-Cœur de Montréal, Montréal, Quebec, Canada; Research Centre, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Faculté de Pharmacie, Université de Montréal, Canada.
¹⁴ Division of Critical Care Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.

PMID: 36682909
DOI: 10.1016/j.jcrc.2023.154254

Abstract

Introduction: Clostridioides difficile infection (CDI) is a serious complication of critical illness. The objective of the study was to determine its incidence, prevalence, timing, severity, predictors, and outcomes.

Methods: We performed a prospective nested cohort study of CDI within a randomized trial comparing Lactobacillus rhamnosus GG to placebo. We adjudicated cases of CDI using standardized definitions, assessed timing (pre-ICU, in ICU, post-ICU) and severity. We analyzed risk factors and outcomes.

Results: Of 2650 patients, 86 were diagnosed with CDI during 90,833 hospital-days (0.95/1000 hospital-days); CDI prevalence was 3.2%. CDI incidence varied in timing; 0.3% patients had CDI pre-ICU, 2.2% in the ICU; an 0.8% developed CDI post-ICU. Relapse or recurrence of CDI was documented in 9.3% patients. Infections were mild/moderate in severity. Complications included septic shock (26.7%), organ failure (16.3%), and toxic megacolon requiring colectomy (1.2%). No risk factors for CDI were identified. CDI was not associated with hospital mortality. The duration of hospital stay was longer for those who had CDI compared those who did not, CONCLUSION: CDI was uncommon, severity was mild to moderate and not associated with mortality however CDI was associated with a longer hospital stay.

Trial registration: ClinicalTrials.gov NCT02462590.

Keywords: Clostridioides difficile infection; Critical illness; Epidemiology; Probiotics.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Clostridioides difficile*
Clostridium Infections* / diagnosis
Clostridium Infections* / drug therapy
Clostridium Infections* / epidemiology
Cohort Studies
Critical Illness
Humans
Prospective Studies
Respiration, Artificial / adverse effects
Retrospective Studies

Associated data

ClinicalTrials.gov/NCT02462590

Grants and funding

CIHR/Canada