Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Dec 1;3(1):ofv186.
doi: 10.1093/ofid/ofv186. eCollection 2016 Jan.

Prevalence and Clinical Outcomes of Clostridium difficile Infection in the Intensive Care Unit: A Systematic Review and Meta-Analysis

Styliani Karanika  1 , Suresh Paudel  1 , Fainareti N Zervou  1 , Christos Grigoras  1 , Ioannis M Zacharioudakis  1 , Eleftherios Mylonakis  1
Affiliations

Prevalence and Clinical Outcomes of Clostridium difficile Infection in the Intensive Care Unit: A Systematic Review and Meta-Analysis

Styliani Karanika et al. Open Forum Infect Dis. .

Abstract

Background. Intensive care unit (ICU) patients are at higher risk for Clostridium difficile infection (CDI).

Methods: We performed a systematic review and meta-analysis of published studies from 1983 to 2015 using the PubMed, EMBASE, and Google Scholar databases to study the prevalence and outcomes of CDI in this patient population. Among the 9146 articles retrieved from the studies, 22 articles, which included a total of 80 835 ICU patients, were included in our final analysis. Results. The prevalence of CDI among ICU patients was 2% (95% confidence interval [CI], 1%-2%), and among diarrheic ICU patients the prevalence was 11% (95% CI, 6%-17%). Among CDI patients, 25% (95% CI, 5%-51%) were diagnosed with pseudomembranous colitis, and the estimated length of ICU stay before CDI acquisition was 10.74 days (95% CI, 5%-51%). The overall hospital mortality among ICU patients with CDI was 32% (95% CI, 26%-39%), compared with 24% (95% CI, 14%-36%) among those without CDI presenting a statistically significant difference in mortality risk (P = .030). It is worth noting that the length of ICU and hospital stay among CDI patients was significantly longer, compared with non-CDI patients (standardized mean of difference [SMD] = 0.49, 95% CI, .39%-.6%, P = .00 and SMD = 1.15, 95% CI, .44%-1.91%, P = .003, respectively). It is noteworthy that the morbidity score at ICU admission (Acute Physiology and Chronic Health Evaluation II [APACHE II]) was not statistically different between the 2 groups (P = .911), implying that the differences in outcomes can be attributed to CDI. Conclusions. The ICU setting is associated with higher prevalence of CDI. In this setting, CDI is associated with increased hospital mortality and prolonged ICU and overall hospital stay. These findings highlight the need for additional prevention and treatment studies in this setting.

Keywords: C difficile infection; ICU; length of stay; meta-analysis; mortality.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
PRISMA flow diagram of meta-analysis. Abbreviations: CDI, Clostridium difficile infection; ICU, intensive care unit.
Figure 2.
Figure 2.
Forest plot of included studies stratified by continent. Individuals and combined prevalence estimates of Clostridium difficile infection among intensive care unit patients.
Figure 3.
Figure 3.
Forest plot of included studies. Standard mean difference (SMD) in length of stay between Clostridium difficile infection (CDI) and non-CDI group (A) in intensive care unit (ICU) (B) in hospital. Abbreviation: CI, confidence interval.
Figure 4.
Figure 4.
Forest plot of included studies. Risk difference (RD) estimate in hospital mortality between Clostridium difficile infection (CDI) and non-CDI group. Abbreviation: CI, confidence interval.
See this image and copyright information in PMC

References

    1. Riddle DJ, Dubberke ER. Clostridium difficile infection in the intensive care unit. Infect Dis Clin North Am 2009; 23:727–43. - PMC - PubMed
    1. Liolios A, Oropello JM, Benjamin E. Gastrointestinal complications in the intensive care unit. Clin Chest Med 1999; 20:329–45, viii. - PubMed
    1. Lucado J, Gould C, Elixhauser A. Clostridium difficile Infections (CDI) in Hospital Stays, 2009: Statistical Brief #124. Rockville, MD: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs, 2006. - PubMed
    1. Rowland SP, Dharmarajah B, Moore HM et al. . Inferior vena cava filters for prevention of venous thromboembolism in obese patients undergoing bariatric surgery: a systematic review. Ann Surg 2015; 261:35–45. - PubMed
    1. Wells G, Shea B, O'Connell D et al. . The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed 1 December 2015.

LinkOut - more resources