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.
Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada.
J Crit Care. 2023 Jun;75:154254. doi: 10.1016/j.jcrc.2023.154254. Epub 2023 Jan 20.
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.
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.
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.
艰难梭菌感染（CDI）是危重病的严重并发症。本研究的目的是确定其发病率、患病率、时间、严重程度、预测因素和结局。
我们在一项比较鼠李糖乳杆菌 GG 与安慰剂的随机试验中进行了前瞻性嵌套队列研究，以确定 CDI。我们使用标准化定义来判断 CDI 的病例，并评估其时间（入 ICU 前、在 ICU 中、出 ICU 后）和严重程度。我们分析了风险因素和结局。
在 2650 名患者中，90833 个住院日中有 86 名（0.95/1000 住院日）诊断为 CDI；CDI 的患病率为 3.2%。CDI 的发病率在时间上有所不同；0.3%的患者在 ICU 前患有 CDI，2.2%的患者在 ICU 中患有 CDI；0.8%的患者在 ICU 后患有 CDI。9.3%的患者记录了 CDI 的复发或再发。感染的严重程度为轻度/中度。并发症包括感染性休克（26.7%）、器官衰竭（16.3%）和需要结肠切除术的中毒性巨结肠（1.2%）。未确定 CDI 的危险因素。CDI 与住院死亡率无关。与没有 CDI 的患者相比，患有 CDI 的患者的住院时间更长。
CDI 并不常见，严重程度为轻度至中度，与死亡率无关，但与住院时间延长有关。
