BackgroundCritically ill patients in the intensive care unit (ICU) are at high risk for developing Clostridioides difficile infections (CDI). Risk factors predicting their mortality or standardized treatment recommendations have not been defined for this cohort. Our goal is to determine outcome and mortality associated risk factors for patients at the ICU with CDI by evaluating clinical characteristics and therapy regimens.MethodsA retrospective single-centre cohort study. One hundred forty-four patients (0.4%) with CDI-associated diarrhoea were included (total 36.477 patients admitted to 12 ICUs from January 2010 to September 2015). Eight patients without specific antibiotic therapy were excluded, so 132 patients were analysed regarding mortality, associated risk factors and therapy regimens using univariate and multivariate regression.ResultsTwenty-eight-day mortality was high in patients diagnosed with CDI (27.3%) compared to non-infected ICU patients (9%). Patients with non CDI-related sepsis (n = 40/132; 30.3%) showed further increase in 28-day mortality (45%; p = 0.003). Initially, most patients were treated with a single CDI-specific agent (n = 120/132; 90.9%), either metronidazole (orally, 35.6%; or IV, 37.1%) or vancomycin (18.2%), or with a combination of antibiotics (n = 12/132; 9.1%). Patients treated with metronidazole IV showed significantly longer duration of diarrhoea > 5 days (p = 0.006). In a multivariate regression model, metronidazole IV as initial therapy was an independent risk factor for delayed clinical cure. Immunosuppressants (p = 0.007) during ICU stay lead to increased 28-day mortality.ConclusionTreatment of CDI with solely metronidazole IV leads to a prolonged disease course in critically ill patients.

中文翻译：

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初始治疗会影响艰难梭菌感染 (CDI) 重症患者的腹泻持续时间

背景重症监护病房 (ICU) 中的重症患者发生艰难梭菌感染 (CDI) 的风险很高。尚未为该队列定义预测其死亡率或标准化治疗建议的风险因素。我们的目标是通过评估临床特征和治疗方案来确定 ICU 中 CDI 患者的预后和死亡率相关危险因素。方法一项回顾性单中心队列研究。144 名 CDI 相关腹泻患者（0.4%）被纳入研究（2010 年 1 月至 2015 年 9 月，共 36.477 名患者入住 12 个 ICU）。8 名未接受特定抗生素治疗的患者被排除在外，因此使用单变量和多变量回归分析了 132 名患者的死亡率、相关危险因素和治疗方案。结果与未感染的 ICU 患者 (9%) 相比，诊断为 CDI 的患者 (27.3%) 的 28 天死亡率较高。非 CDI 相关脓毒症患者（n = 40/132；30.3%）的 28 天死亡率进一步增加（45%；p = 0.003）。最初，大多数患者接受单一 CDI 特异性药物治疗（n = 120/132；90.9%），甲硝唑（口服，35.6%；或静脉注射，37.1%）或万古霉素（18.2%），或联合使用抗生素（n = 12/132；9.1%）。接受甲硝唑 IV 治疗的患者的腹泻持续时间显着延长 > 5 天 (p = 0.006)。在多元回归模型中，甲硝唑 IV 作为初始治疗是延迟临床治愈的独立危险因素。ICU 住院期间使用免疫抑制剂 (p = 0.007) 会导致 28 天死亡率增加。