• Saif A Musa, Carl Moran, Sam J Thomson, Matthew L Cowan, Greg McAnulty, Michael Grounds, and Tony Manibur Rahman.
• Department of Gastroenterology and Hepatology, St George's Hospital, London, UK. catchMusa@hotmail.com
• J. Cardiothorac. Vasc. Anesth. 2011 Apr 1; 25 (2): 263-7.

ObjectivesTo determine the prevalence, severity, and outcome associated with Clostridium difficile-associated disease (CDAD) acquired while in the cardiothoracic intensive care unit (CTICU).DesignA 5-year retrospective study.SettingThe CTICU.ParticipantsAll CTICU patients with a positive C difficile stool toxin assay 48 hours after admission.InterventionsNone.Measurements And Main ResultsThe results of all CTICU patients with a positive C difficile stool toxin assay were obtained from the Microbiology Department. Each patient's medical notes and charts then were reviewed in turn. A total of 27 of 5,199 (0.5%) CTICU patients acquired CDAD. The median age was 74 years (IQR 68-77), and 17 (63%) patients were male. There were 21 (78%) surgical patients; 13 (62%) were elective admissions. The most frequent diagnosis on admission was valvular heart disease (10 [37%] patients). Sixteen (59%) patients underwent coronary artery bypass graft (CABG) surgery and/or valvular heart surgery. The median interval between CTICU admission and CDAD diagnosis was 10 days (IQR 5-18). Previously identified risk factors for ICU-acquired CDAD included age >65 years (23), antibiotic use (26), and medical device requirements (27). At the time of diagnosis, 14 (52%) patients had moderate CDAD. After treatment initiation, 8 (30%) patients developed worsening CDAD. The 30-day in-hospital mortality rate for CTICU-acquired CDAD was 26% (7 patients).ConclusionsC difficile-associated disease rarely is acquired in the CTICU. Approximately one third of patients may experience disease progression, and just over a quarter may die within 30 days of diagnosis. The implementation of recommended severity definitions and treatment algorithms may reduce complication rates and merits prospective evaluation.Copyright © 2011. Published by Elsevier Inc.

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