1399. Clostridium difficile infection presentation and recurrence risks in spinal cord and traumatic brain injury patients in an inpatient rehabilitation hospital
Session: Poster Abstract Session: Clostridium difficile
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • Pawlowski.Cdiff SCI.IDSA 2013.pdf (194.1 kB)
  • Background: Clostridium difficile is a common cause of healthcare associated diarrhea and colonizer of patients in rehabilitation centers. There is little known regarding C.difficile infection (CDI) in long term rehabilitation centers and spinal cord (SCI) or traumatic brain injury (TBI) patients, many with neurogenic bowels.  We undertook this study to evaluate CDI presentation and recurrence in rehabilitation hospital patients.

    Methods: We performed a retrospective cohort study on SCI and TBI patients with CDI at a specialized SCI/TBI hospital. CDI was defined as a positive toxin assay at the study hospital and treatment with C.difficile active antibiotics. Charts were analyzed for length of stay (LOS), neurologic injury, infections, antibiotics, and recurrence. White blood cell count (WBC), creatinine (Cr), temperature (temp), and stool output were assessed. The primary objectives were to identify factors associated with CDI recurrence and better define CDI presentation in this population.

    Results: 109 patients were included; 74 (68%) with SCI and 35 (32%) with TBI or TBI with SCI. Median age was 33. The median LOS at the pre transfer and study facilities were 30 d and 94 d respectively. All were treated for an infection or exposed to antibiotics prior to CDI (pre transfer or study hospital). 103 (94%) received antibiotics at the study hospital; fluoroquinolones (71, 65%), trimethoprim/sulfamethoxazole (51, 46%), and 3rd-5thgeneration cephalosporins (45, 41%) were commonly prescribed. UTI (86, 79%) and pulmonary infections (38, 35%) were commonly diagnosed and treated. Stool frequency and volume increased on the diagnosis day vs 24-48 hr prior (2.9 BM/d, 5 cup vs 1.6 BM/d, 2.7 cup,  p<0.001); average WBC, Cr, and temps were normal. 32 (29%) were diagnosed with CDI at the pre transfer hospital or within the first 3 hospital days indicating possible carriage. 38 (35%) recurred; recurrent patients had longer LOS (116 d vs 92 d, p=0.006). TBI was associated with increased risk of recurrence (OR  2.9, 95%CI 1.2-6.6).

    Conclusion: SCI and TBI patients with CDI in a rehabilitation setting represent a population with prolonged LOS, high recurrence rates, and subtle presentation. Efforts to decrease healthcare associated infections such as UTI’s, antibiotic usage, and better define CDI in this specific population may decrease CDI diagnoses.

    Sean Pawlowski, MD, Colorado Infectious Disease Associates, Denver, CO, Rosa Lozano, CIC, Craig Hospital, Englewood, CO and Karrine Roberts, University of Colorado-Denver, Aurora, CO


    S. Pawlowski, None

    R. Lozano, None

    K. Roberts, None

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