The following is a summary of “Clostridioides difficile infection in mechanically ventilated critically ill patients: A nested cohort study,” published in the April 2023 issue of Critical Care by Dionne et al.

Clostridioides difficile infection (CDI) is a grave complication that can arise during critical illness. The study aimed to ascertain the incidence, prevalence, timing, severity, predictors, and outcomes of the condition under investigation. A prospective nested cohort study was conducted on CDI in a randomized trial that compared Lactobacillus rhamnosus GG to a placebo. Researchers employed standardized definitions to adjudicate cases of CDI and evaluated the timing of CDI occurrence (i.e., pre-ICU, in ICU, post-ICU) and its severity. Risk factors and outcomes were analyzed.

Among a cohort of 2650 patients, 86 individuals were diagnosed with CDI throughout 90,833 hospital days, resulting in a CDI prevalence of 3.2%. The incidence rate of CDI was calculated to be 0.95 per 1000 hospital days. The incidence of Clostridioides difficile infection (CDI) exhibited temporal variability. Specifically, 0.3% of patients presented with CDI before admission to the intensive care unit (ICU), while 2.2% acquired CDI during their ICU stay. Additionally, 0.8% of patients developed CDI following their ICU discharge. A documented relapse or recurrence of CDI was observed in 9.3% of the patients. The severity of the infections ranged from mild to moderate. 

The patient experienced various complications, namely septic shock (26.7%), organ failure (16.3%), and toxic megacolon necessitating colectomy (1.2%). No discernible risk factors were identified for CDI. CDI did not correlate with mortality rates within the hospital setting. The patients who contracted CDI experienced a prolonged hospitalization period compared to those who did not. Although CDI was uncommon, its severity ranged from mild to moderate and did not result in mortality. Nonetheless, CDI was linked to an extended duration of hospital stay.

Source: sciencedirect.com/science/article/abs/pii/S0883944123000035