Clinical characteristics and outcomes of Clostridioides difficile infection in the intensive care unit: a KASID multi-centre study

Background: Despite the growing clinical and economic burden of Clostridioides difficile infection (CDI), data on CDI in the intensive care unit (ICU) in the Asia-Pacific region are lacking.Methods: This retrospective study analysed 191 patients who were treated with CDI in the ICUs of three hospitals in South Korea from January 2017 to May 2021. Backward-stepwise multiple logistic regression was used to identify factors influencing the treatment response and mortality.Results: Fifty-eight patients (30.4%) were considered immunocompromised. The mean Charlson comorbidity index was 5.65 & PLUSMN; 2.39 (10-year survival rate: 21%), the APACHE II score was 20.86 & PLUSMN; 7.78 (mortality rate: 40%), the ATLAS score was 5.45 & PLUSMN; 1.59 (cure rate: 75%), and the SOFA score was 7.97 & PLUSMN; 4.03 (mortality rate: 21.5%). Fifty-eight (30.4%) of the CDI cases were severe and 40 (20.9%) were fulminant. Oral vancomycin or oral met-ronidazole was the most frequently first-line treatments (N = 57; 32.6%). The 10-day response rate was 59.7% and the eight-week overall mortality rate was 41.4%. Fulminant CDI (OR 0.230; 95% CI 0.085-0.623) and each one-unit increment in the SOFA score (OR 0.848; 95% CI 0.759-0.947) were associated with treatment failure. High APACHE II (OR 0.355; 95% CI 0.143-0.880) and SOFA (OR 0.164; 95% CI 0.061-0.441) scores were asso-ciated with higher mortality.Conclusions: High-risk patients in the ICU had a higher mortality rate and a lower cure rate of CDI. Further research is required to provide more accurate prediction scoring systems and better clinical outcomes.& COPY; 2023 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.