483. Clinical Characteristics of Military Trauma Patients with Clostridium difficile Infections
Session: Poster Abstract Session: Healthcare Epidemiology: Updates in C. difficile
Thursday, October 4, 2018
Room: S Poster Hall
Background: Clostridium difficile-associated diarrhea (CDAD) is an important cause of nosocomial diarrhea with increasing morbidity, mortality, and healthcare costs. There is growing recognition that critically ill trauma patients comprise a unique at risk population. This study describes the clinical epidemiology of CDAD in military trauma patients.

Methods: Through the Trauma Infectious Disease Outcomes Study (TIDOS), patients with a diagnosis of confirmed (laboratory supported) or presumptive (diarrhea with treatment for CDAD in absence of lab confirmation) CDAD (9/09-2/14) were analyzed. Patient demographic, injury, and infection data were evaluated. CDAD severity was defined per 2017 IDSA guidelines.

Results: Of 2660 patients, 19 and 4 patients with confirmed and presumptive CDAD respectively were identified with an incidence of 2.76/10,000 (95% CI: 1.75-4.15) occupied bed days. Sixteen (70%) had blast injuries, 4 had gunshot wounds, and 3 had other injuries. Median age was 24 years (IQR 23, 31). Median injury severity score was 38 (IQR 26, 47). Severe and fulminant CDAD was diagnosed in 8 (35%) and 6 (26%), respectively. Patients had a median hospitalization of 12 days (IQR 9.5, 34) and 3 OR visits (IQR 2, 6) prior to CDAD diagnosis. Nineteen (83%) patients were in the ICU and 17 (74%) were intubated prior to or upon diagnosis. Seventeen patients had ≥1 infection before CDAD diagnosis, largely pneumonia (47%) and skin and soft tissue infections (47%). Most patients (96%) were on antibiotics pre-CDAD diagnosis: 1st generation cephalosporins (1GC; 96%), tetracyclines (87%), vancomycin (74%), carbapenems (70%), and fluoroquinolones (FQ; 57%). Five (22%) received clindamycin. Of the 2637 patients without CDAD, 91% received antimicrobials during hospitalization (86% a 1GC, 47% FQ, and 16% clindamycin). Median length of hospital stay after CDAD diagnosis was 34 days (IQR 16, 55). Treatment included only oral metronidazole in 15 patients, IV metronidazole in 2, and some combination of oral vancomycin, metronidazole, and IV metronidazole in 6. No patients died.

Conclusion: Despite high rates of antimicrobial usage in this severely injured population, CDAD was uncommon. Though CDAD was severe or fulminant in >50%, no patients died.

Sarah Schall, MD, Internal Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX, Ping Li, MS, Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, Teresa Merritt, BS, Wilford Hall USAF Medical Center (WHMC), San Anotnio, TX, Leigh Carson, MS, Preventive Medicine and Biostatistics, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, Timothy J. Whitman, DO, Walter Reed National Military Medical Center, Bethesda, MD, Joseph L. Petfield, MD, Landstuhl Regional Medical Center, Landstuhl, Germany, David R. Tribble, MD, DrPH, Infectious Disease Clinical Research Program, Uniformed Services University, Bethesda, MD and Dana M. Blyth, MD, Dept of Medicine, Brooke Army Medical Center, Fort Sam Houston, TX


S. Schall, None

P. Li, None

T. Merritt, None

L. Carson, None

T. J. Whitman, None

J. L. Petfield, None

D. R. Tribble, None

D. M. Blyth, None

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