• Joanna C Dionne, Jennie Johnstone, Diane Heels-Ansdell, Erick Duan, Francois Lauzier, Yaseen M Arabi, AdhikariNeill K JNKJDepartment of Critical Care Medicine, Sunnybrook Health Sciences Centre, Interdepartmental Division of Critical Care Medicine, University of Toronto, Canada., Wendy Sligl, Peter Dodek, Bram Rochwerg, John C Marshall, Daniel J Niven, David R Williamson, Steven Reynolds, Nicole Zytaruk, and Deborah Cook.
• Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Farncombe Family Digestive Health Research Institute, McMaster University Hamilton, Ontario, Canada; Department of Health Research Methods, Evaluation and Impact, McMaster University, Canada. Electronic address: Joanna.dionne@medportal.ca.
• J Crit Care. 2023 Jun 1; 75: 154254154254.

IntroductionClostridioides difficile infection (CDI) is a serious complication of critical illness. The objective of the study was to determine its incidence, prevalence, timing, severity, predictors, and outcomes.MethodsWe performed a prospective nested cohort study of CDI within a randomized trial comparing Lactobacillus rhamnosus GG to placebo. We adjudicated cases of CDI using standardized definitions, assessed timing (pre-ICU, in ICU, post-ICU) and severity. We analyzed risk factors and outcomes.ResultsOf 2650 patients, 86 were diagnosed with CDI during 90,833 hospital-days (0.95/1000 hospital-days); CDI prevalence was 3.2%. CDI incidence varied in timing; 0.3% patients had CDI pre-ICU, 2.2% in the ICU; an 0.8% developed CDI post-ICU. Relapse or recurrence of CDI was documented in 9.3% patients. Infections were mild/moderate in severity. Complications included septic shock (26.7%), organ failure (16.3%), and toxic megacolon requiring colectomy (1.2%). No risk factors for CDI were identified. CDI was not associated with hospital mortality. The duration of hospital stay was longer for those who had CDI compared those who did not, CONCLUSION: CDI was uncommon, severity was mild to moderate and not associated with mortality however CDI was associated with a longer hospital stay.Crown Copyright © 2023. Published by Elsevier Inc. All rights reserved.

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