Length of stay and mortality due to Clostridium difficile infection acquired in the intensive care unit

J Crit Care. 2013 Aug;28(4):335-40. doi: 10.1016/j.jcrc.2012.11.008. Epub 2013 Jan 18.


Purpose: The purpose of this study was to determine the attributable intensive care unit (ICU) and hospital length of stay and mortality of ICU-acquired Clostridium difficile infection (CDI).

Materials and methods: In this retrospective cohort study of 3 tertiary and 3 community ICUs, we screened all patients admitted between April 2006 and December 2011 for ICU-acquired CDI. Using both complete and matched cohort designs and Cox proportional hazards analysis, we determined the association between CDI and ICU and hospital length of stay and mortality. Adjustment or matching variables were site, age, sex, severity of illness, and year of admission; any infection as an ICU admitting or acquired diagnosis before the diagnosis of CDI and diagnosis of CDI were time-dependent exposures.

Results: Of 15314 patients admitted to the ICUs during the study period, 236 developed CDI in the ICU. In the complete cohort analysis, the hazard ratios (95% confidence interval) for CDI related to ICU and hospital discharge were 0.82 (0.72, 0.94) and 0.83 (0.73, 0.95), respectively (0.5 additional ICU days and 3.4 hospital days), and related to death in ICU and hospital, they were 1.00 (0.73, 1.38) and 1.19 (0.93, 1.52), respectively. In the matched analysis, the hazard ratios for CDI related to ICU and hospital discharge were 0.91 (0.81, 1.03) and 0.98 (0.85, 1.13), respectively, and related to death in ICU and hospital, they were 1.18 (0.85, 1.63) and 1.08 (0.82, 1.43), respectively.

Conclusions: C difficile infection acquired in ICU is associated with an increase in length of ICU and hospital stay but not with any difference in ICU or hospital mortality.

Keywords: Clostridium difficile infection; Intensive care unit; Length of stay; Mortality.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • British Columbia / epidemiology
  • Clostridioides difficile
  • Clostridium Infections / mortality*
  • Cross Infection / mortality*
  • Female
  • Humans
  • Intensive Care Units*
  • Length of Stay / statistics & numerical data*
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Retrospective Studies
  • Severity of Illness Index