Clostridium difficile infection: A multicenter study of epidemiology and outcomes in mechanically ventilated patients

Objectives: Clostridium difficile is a leading cause of hospital-associated infection in the United States. The purpose of this study is to assess the prevalence of C. difficile infection among mechanically ventilated patients within the ICUs of three academic hospitals and secondarily describe the influence of C. difficile infection on the outcomes of these patients. Design: A retrospective cohort study. Setting: ICUs at three teaching hospitals: Barnes-Jewish Hospital, Mayo Clinic, and Creighton University Medical Center over a 2-year period. Patients: All hospitalized patients requiring mechanical ventilation for greater than 48 hours within an ICU were eligible for inclusion. Interventions: None. Measurements and Main Results: A total of 5,852 consecutive patients admitted to the ICU were included. Three hundred eighty-six (6.6%) patients with development of C. difficile infection while in the hospital (5.39 cases/1,000 patient days). Septic shock complicating C. difficile infection occurred in 34.7% of patients. Compared with patients without C. difficile infection (n = 5,466), patients with C. difficile infection had a similar hospital mortality rate (25.1% vs 26.3%, p = 0.638). Patients with C. difficile infection were significantly more likely to be discharged to a skilled nursing or rehabilitation facility (42.4% vs 31.9%, p <0.001), and the median hospital (23 d vs 15 d, p <0.001) and ICU length of stay (12 d vs 8 d, p <0.001) were found to be significantly longer in patients with C. difficile infection. Conclusions: Clostridium difficile infection is a relatively common nosocomial infection in mechanically ventilated patients and is associated with prolonged length of hospital and ICU stay, and increased need for skilled nursing care or rehabilitation following hospital discharge.