2113. Adherence to Treatment Guidelines for Incident Clostridium difficile Infection in Critically Ill Adults
Session: Poster Abstract Session: Clostridium difficile: Therapeutics
Saturday, October 29, 2016
Room: Poster Hall
  • C diff infection - 10-18-16_PDF.pdf (387.0 kB)
  • Background:

    Treatment guidelines for Clostridium difficle infection (CDI) based on severity define severe

    CDI as leukocyte count greater than 15000/ul or serum creatinine (Cr) ratio greater than 1.5 times baseline.

    Hypotension, shock, ileus and megacolon signify severe-complicated CDI. These metabolic

    derangements and clinical syndromes are common among intensive care unit (ICU) patients

    without CDI, thus increasing the potential difficulty in determining the severity and appropriate

    treatment for CDI among ICU patients. We sought to evaluate adherence to treatment guidelines

    in this population.


    Retrospective observational study of critically ill adults with incident CDI diagnosed 48 hours or more

    after ICU admission, admitted to a tertiary care center between January 1, 2011 and December

    31, 2013 was completed. Data on demographics, clinical details, laboratory values and

    medications were abstracted.


    Overall, 67 patients with median age 66 years (range 19-98), 58.2% males, median Charlson

    Comorbidity score of 5 (range 0-15) and a median Apache III score of 42.5(range 14-115) on

    ICU admission were included. Of these patients, 31(46.3%) did not have a baseline Cr and Cr at

    ICU admission was used. There were 36 (53.7%) mild/moderate, 16 (23.9%) severe and 15

    (22.4%) severe complicated CDI patients. The majority (n=40, 59.7%) were treated with

    metronidazole, 8 (11.9%) with vancomycin and 17(25.4%) with both medications.

    Overall 36 (55.4%) had treatment appropriate for clinical severity, however 29 (44.6%) did not,

    2 received no treatment secondary to death or transition to comfort cares. Two patients required

    colectomy (1 with appropriate treatment, 1 without). Eleven patients had a subsequent positive

    CDI at least 14 days after initial testing and of these, 5 had severity discordant therapy.


    This study highlights that determination of attributable severity of illness among critically ill

    patients with CDI is difficult to assess by current guidelines definitions and clinician treatment

    may be discordant with these definitions in many cases. Further study is necessary to develop

    appropriate severity scoring systems and treatment decision algorithms for CDI among the

    critically ill.

    Kelly Cawcutt, MD, University of Nebraska Medical Center, Omaha, NE, Alberto Marquez, RRT, Mayo Clinic, Rochester, MN, Rodrigo Cartin-Ceba, MD, Mayo Clinic, Phoenix, AZ, Larry M. Baddour, MD, FIDSA, Infectious Diseases, Mayo Clinic, Rochester, MN and Sahil Khanna, MBBS, MS, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN


    K. Cawcutt, None

    A. Marquez, None

    R. Cartin-Ceba, None

    L. M. Baddour, None

    S. Khanna, Rebiotix Inc.: Investigator and Scientific Advisor , Consulting fee and Research support

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.