From ward to intensive care unit: clinical drivers of adverse outcomes in Clostridioides difficile infection - A retrospective cohort study.

BACKGROUND/

OBJECTIVES

Clostridioides difficile infection (CDI) remains a major cause of nosocomial diarrhoea, with intensive care unit (ICU) and intermediate care (IMC) patients experiencing particularly high morbidity and mortality. Although prognostic models exist, predictive accuracy remains limited. This study aimed to identify determinants of adverse CDI outcomes, recurrence, and prolonged hospitalization in a tertiary care setting.

METHODS

We retrospectively analysed 87 hospitalized CDI cases (2012-2014). Severe CDI was defined by laboratory and clinical criteria. The primary endpoint was major adverse clinical events CDI (MACE-CDI: surgery, in-hospital mortality, or a severe, complicated course). Secondary outcomes included recurrence and length of stay. Logistic and linear regression analyses with bootstrap validation (1000 iterations) were performed.

RESULTS

Among 87 patients (mean age: 60.7 ± 15.2 years; 48% ≥65 years; 53% immunosuppressed), 37 (42.5%) required ICU/IMC admission. MACE-CDI occurred in 16.1% and was associated with ICU admission (odds ratio [OR]: 4.26, 95% confidence interval [CI]: 1.29-16.76; P=0.017). In-hospital mortality (13.8%) was linked to ICU admission (OR: 8.89, 95% CI: 2.15-60.65; P=0.0017) and age ≥55 years. Sodium bicarbonate therapy (SBT) predicted a poor outcome (OR: 2.9, P=0.028). The CDI recurrence occurred in 21.8%. Vancomycin-resistant Enterococcus (VRE) colonization conferred a >16-fold increased risk in ICU/IMC patients (OR: 16.20, P=0.015). Parenteral nutrition (PN) was consistently associated with severe CDI (OR: 2.49, P=0.041) and prolonged hospitalization, alongside ascites (P<0.01). Piperacillin/tazobactam and cephalosporin exposure increased nosocomial/severe CDI risk, whereas trimethoprim/sulphamethoxazole appeared to be a lower-risk alternative.

CONCLUSIONS

Older age, ICU admission, ascites, VRE colonization, SBT, and PN correlated with adverse CDI outcomes. These factors may inform stewardship/management strategies in high-risk patients.