Predictors of Clostridium difficile infection severity in patients hospitalised in medical intensive care

Table 1 Comparison of the characteristics of severe and non-severe Clostridium difficile infection patients hospitalised in medical intensive care unit between January 2007 and December 2011

	Total	Severe CDI	Non-severe CDI	P value
	n = 40	n = 15	n = 25
Age (yr)	62.9 (55.3-72.4)	59.52 (54.8-77.3)	64.27 (56.1-72.2)	0.99
Male gender	27 (67.5)	13 (86.7)	14 (56.0)	0.045
Origin of patient				0.61
Home	14 (35.0)	6 (40)	8 (32)
Other ward and/or other hospital	26 (65.0)	9 (60)	17 (68)
Diagnosis at MICU admission				0.39
Respiratory disease	15 (37.5)	3 (20)	12 (48)
Septic shock	12 (30.0)	6 (40)	6 (24)
Renal disease	3 (7.5)	1 (6.7)	2 (8)
Gastrointestinal disease	3 (7.5)	1 (6.7)	2 (8)
Neurological disease	3 (7.5)	1 (6.7)	2 (8)
Other	4 (10.0)	3 (20)	1 (4)
Clinical symptoms and biological features at diagnosis
Fever	23 (57.5)	8 (53.3)	15 (60.0)	0.75
Abdominal pain	15 (37.5)	7 (46.7)	8 (32.0)	0.35
Duration of diarrhoea (d)	13.0 (8.0-19.5)	18 (5-29)	13 (8-17)	0.38
C-reactive protein (mg/L)	117 (60-193)	185 (73-339)	105 (39-127)	0.01
Albumin count (g/L)	26.0 (20.0-28.0)	23 (17-27)	26 (21-28)	0.30
Leukocyte count (x 109/L)	14.4 (9.5-21.7)	17.9 (10.6-33.4)	12.4 (9.0-21.1)	0.17
Previous exposure to CDI risk factors within 8 wk before onset of symptoms
Hospitalisation	28 (70.0)	10 (66.7)	18 (72.0)	0.72
Exposure to PPI	21 (52.5)	10 (66.7)	11 (44.0)	0.17
Chemotherapy	12 (30)	5 (33.3)	7 (28.0)	0.72
Gastrointestinal procedures	23 (57.5)	9 (60.0)	14 (56.0)	0.80
Antibiotic treatment	38 (95.0)	15 (100)	23 (92)	0.26
Cephalosporins 3rd generation	22 (55)	8 (53.3)	14 (56)	0.87
Clindamycin	2 (5)	1 (6.7)	1 (4)	0.71
Coamoxiclav	16 (40)	8 (53.3)	8 (32)	0.18
Fluoroquinolones	26 (65)	13 (86.7)	13 (52)	0.026
Treatment				0.06
No treatment	5 (12.5)	2 (13.3)	3 (12.0)
Only metronidazole	25 (62.5)	6 (40)	19 (76)
Only vancomycin	2 (5)	2 (13.3)	0 (0)
Metronidazole+vancomycin	8 (20)	5 (33.3)	3 (12.0)
Duration of hospital stay (d) and outcomes
LOS in hospital	27.0 (13.5-50.8)	16 (5-48)	28.0 (16.0-55.5)	0.26
LOS in MICU	14.0 (5.0-22.8)	8 (2-21)	16.0 (6.0-25.5)	0.27
Death in 30 d	16 (40)	9 (60)	7 (28)	0.046

Data represent n (%) of patients for categorical variables and median (interquartile range) for continuous variables. CDI: Clostridium difficile infection; LOS: Length of stay; MICU: Medical intensive care unit; PPI: Proton pump inhibitor; WBC: White blood cells.

Table 2 Factors independently associated with severe Clostridium difficile infection among patients in medical intensive care unit

Variables	Unadjusted OR (95%CI)	P value	Adjusted OR (95%CI)	P value
Glasgow coma score	1.16 (0.99-1.36)	0.15	-
Diabetes mellitus	4.89 (1.00-23.93)	0.04	-
Previous PPI exposure	2.55 (0.67-9.66)	0.17	-
Coamoxiclav (in the previous 8 wk)	2.43 (0.65-9.07)	0.18	-
Fluoroquinolones (in the previous 8 wk)	6.0 (1.12-32.28)	0.026	9.29 (1.16-74.28)	0.036
C-reactive protein (mg/L; 10 mg/L increments)	1.10 (1.02-1.18)	0.014	1.11 (1.02-1.21)	0.021
Male gender	5.11 (0.95-27.55)	0.045	8.45 (1.06-67.16)	0.044

Exposure to fluoroqionolones, C-reactive protein level and gender were included in the multivariate model [The value of the likelihood was 34.56 with 3 df, and χ² test: 18.37 (P < 0.0001)]. OR: Odds ratios; PPI: Proton pump inhibitor.