Risk Factors and Outcomes of Clostridioides difficile Infection in Respiratory Intensive Care Unit Patients.

Abstract

Objective: This retrospective study aimed to investigate the risk factors and clinical outcomes of Clostridioides difficile infection (CDI) in critically ill patients admitted to the respiratory intensive care unit (RICU).

Methods: We enrolled adult patients who developed diarrhea during their stay in the RICU and underwent C. difficile toxin testing. Patients were stratified into two groups based on test results: CDI group and Clostridioides difficile-negative diarrhea (CDN) group. Risk factors for CDI and clinical outcomes were compared between the two groups.

Results: The incidence of CDI in RICU patients was 8.3%. Compared with the CDN group, the CDI group had significantly lower PaO₂/FiO₂ (P/F) ratios (median 135 vs. 189 mmHg, p = 0.012) and higher rates of parenteral nutrition (83.78% vs. 60.0%, p = 0.012), vasopressor use (62.16% vs. 40.0%, p = 0.029), and analgesic administration (72.97% vs. 47.14%, p = 0.01). Multivariate analysis indicated that male sex was a risk factor for CDI (OR, 4.07; 95% CI, 1.25-13.26; p = 0.02). The CDI group had a nonsignificantly higher 60-day mortality rate (35.14% vs. 34.29%; p = 0.976). Survivors of CDI patients exhibited better oxygenation (175.43 vs. 102.88 mmHg; p = 0.004) and lower SOFA scores (6.38 vs. 9.0; p = 0.017). No independent risk factors for mortality were identified. CDI patients had significantly longer RICU stays (median: 32 vs. 21.5 days, p = 0.02).

Conclusion: In this study, male sex was independently associated with an increased risk of CDI. Although CDI did not significantly affect 60-day mortality, it was linked to prolonged RICU hospitalization.