Clostridium difficile-associated diarrhea in medical intensive care units of a medical center in southern Taiwan: A prospective surveillance study

[[abstract]]Purpose: Clostridium difficile infection is the leading etiology among nosocomial infectious diarrhea and is associated with morbidity and mortality. Critically ill patients are thought to be more susceptible to C. difficile-associated diarrhea (CDAD), however the epidemiology and characteristics of CDAD in patients in intensive care units (ICUs) are scanty. The purpose of this study is to analyze the impact of CDAD in medical ICUs. Methods: From March 2013 to March 2014, we prospectively enrolled adult patients developing diarrhea 72 hours after admitted to ICUs. Stool culture for C. difficile was done. All C. difficile isolates were tested fortcdA and tcdB by polymerase chain reaction. A case of CDAD was defined as the development of diarrhea and toxigenic C. difficile detected in stool. Results: In the study period, total 77 diarrheal patients were enrolled and among them 15 CDAD cases were identified. None had pseudomembraneous colitis or toxic megacolon. The incidence rate of CDAD was 9.45 cases per 10,000 patient-days in medical ICUs. Compared to non-CDAD cases, CDAD cases have had a higher body mass index (23.9±4.2 vs. 21.7±5.4, P=0.033). There were no differences in underlying disease, disease severity, and in-hospital mortality rate between the two groups. Nine of 15 cases of CDAD received antibiotic treatment, mostly oral metronidazole, and recovered well. Conclusions: The incidence of CDAD in our ICUs was lower than that expected and was associated with a higher body mass index