Clostridium difficile infection in critically injured trauma patients

Kimberly Lumpkins, Grant V. Bochicchio, Manjari Joshi, Ryan Gens, Kelly Bochicchio, Anne Conway, Stacey Schaub, Thomas Scalea

Research output: Contribution to journalArticle

Abstract

Background: Clostridium difficile infection (CDI) is an increasing problem worldwide. To our knowledge, there are no studies evaluating specifically the incidence of CDI in the critically injured trauma population. Methods: Five hundred eighty-one consecutive critically injured trauma patients were followed prospectively for development of CDI, diagnosed by toxin assay. Testing was ordered on the basis of symptoms. Antibiotic usage was classified as surgical prophylaxis or therapeutic. Results: Nineteen cases of CDI were diagnosed in 581 patients (3.3%). Age, sex, race, and injury severity score (ISS) were similar in patients with and without CDI (p > 0.2); the mean ISS in patients with CDI was 29 points. Intensive care unit length of stay (ICU LOS), ventilator days, and hospital length of stay (HLOS) were significantly higher in the CDI patients. The diagnosis was made a mean of 17 days after admission; however, in four patients (21%), the infections were diagnosed within six days of admission. Fourteen patients (74%) had received therapeutic antibiotics for confirmed or suspected infection prior to the appearance of colitis; four patients (21%) received only intraoperative prophylaxis, and one patient had no antibiotic exposure. These five patients were significantly younger than those who developed CDI after therapeutic antibiotic usage and had significantly shorter HLOS and ICU LOS (p <0.05). This result persisted after controlling for age using multiple linear regression analysis. Conclusions: Clostridium difficile infection occurred in 3.3% of patients and was diagnosed as early as the fourth hospital day. We have identified a unique subgroup of younger patients who developed CDI after minimal or no antibiotic exposure. Further study is needed to characterize this population.

Original languageEnglish (US)
Pages (from-to)497-501
Number of pages5
JournalSurgical Infections
Volume9
Issue number5
DOIs
StatePublished - Oct 1 2008
Externally publishedYes

Fingerprint

Clostridium Infections
Clostridium difficile
Wounds and Injuries
Length of Stay
Anti-Bacterial Agents
Injury Severity Score
Intensive Care Units
Mechanical Ventilators
Colitis
Infection
Population
Linear Models

ASJC Scopus subject areas

  • Surgery
  • Infectious Diseases
  • Microbiology (medical)

Cite this

Lumpkins, K., Bochicchio, G. V., Joshi, M., Gens, R., Bochicchio, K., Conway, A., ... Scalea, T. (2008). Clostridium difficile infection in critically injured trauma patients. Surgical Infections, 9(5), 497-501. https://doi.org/10.1089/sur.2007.071

Clostridium difficile infection in critically injured trauma patients. / Lumpkins, Kimberly; Bochicchio, Grant V.; Joshi, Manjari; Gens, Ryan; Bochicchio, Kelly; Conway, Anne; Schaub, Stacey; Scalea, Thomas.

In: Surgical Infections, Vol. 9, No. 5, 01.10.2008, p. 497-501.

Research output: Contribution to journalArticle

Lumpkins, K, Bochicchio, GV, Joshi, M, Gens, R, Bochicchio, K, Conway, A, Schaub, S & Scalea, T 2008, 'Clostridium difficile infection in critically injured trauma patients', Surgical Infections, vol. 9, no. 5, pp. 497-501. https://doi.org/10.1089/sur.2007.071
Lumpkins K, Bochicchio GV, Joshi M, Gens R, Bochicchio K, Conway A et al. Clostridium difficile infection in critically injured trauma patients. Surgical Infections. 2008 Oct 1;9(5):497-501. https://doi.org/10.1089/sur.2007.071
Lumpkins, Kimberly ; Bochicchio, Grant V. ; Joshi, Manjari ; Gens, Ryan ; Bochicchio, Kelly ; Conway, Anne ; Schaub, Stacey ; Scalea, Thomas. / Clostridium difficile infection in critically injured trauma patients. In: Surgical Infections. 2008 ; Vol. 9, No. 5. pp. 497-501.
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