NEW YORK (Reuters Health) – Patients on prolonged acute mechanical ventilation face an increased risk of Clostridium difficile-associated disease, according to a report in the September Chest.
“C. difficile is frequent in this population, and we need to be vigilant in our prevention efforts,” Dr. Marya D. Zilberberg from University of Massachusetts, Amherst told Reuters Health by email. “Once present, it is critical to contain the spread of C. difficile to other patients.”
Dr. Zilberberg and colleagues used 2005 data from the Health Care Utilization Project/Nationwide Inpatient Sample to examine the rates and outcomes of C. difficile-associated disease among 64,910 hospitalized adults who received prolonged treatment with acute mechanical ventilation.
Among these patients, 5.3% had a concomitant diagnosis of C. difficile-associated disease at death or discharge.
On unadjusted analysis, the primary outcome of the study – hospital mortality – was 32.6% in patients with C. difficile-associated disease and 33.0% in patients without it. In the adjusted analysis, there was “a small but statistically significant difference” in mortality risk, with patients who had C. difficile-associated disease “somewhat less likely” to die in the hospital (adjusted relative risk, 0.89).
In addition, C. difficile-associated disease in patients with prolonged ventilation was associated with substantially greater median hospital length of stay, higher median costs, a greater likelihood of being discharged to a skilled nursing facility, and a lower likelihood of being discharged to home.
“This infection rate of 530 cases per 10,000 hospital admissions is strikingly high compared with that noted in the general hospitalized population (11.2 cases per 10,000 hospitalizations,” the investigators say.
“The most important thing is to minimize the use of antibiotics as much as possible, particularly the classes that are known to select for C. difficile (e.g., quinolones, etc.),” Dr. Zilberberg said. “We are finding that there is a fair bit of community-acquired C. difficile, which may act as a reservoir for hospital-acquired disease. So limiting antibiotics should be a community-wide effort, not just that in the hospital.”
Reference:
Chest 2009;136:752-758.
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