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Prevalence of Clostridioides difficile Infection in Critically Ill Patients with Extreme Leukocytosis and Diarrhea

While early empiric antibiotic therapy is beneficial for patients presenting with sepsis, the presentation of sepsis from Clostridioides difficile (formerly Clostridium difficile) infection (CDI) has not been well studied in large cohorts. We sought to determine whether the combination of extreme le...

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Autores principales: Teja, Bijan, Alibhai, Nafeesa, Rubenfeld, Gordon D., Taggart, Linda R., Jivraj, Naheed, Hirji, Sameer A., O’Gara, Brian P., Shaefi, Shahzad
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7839043/
https://www.ncbi.nlm.nih.gov/pubmed/33401377
http://dx.doi.org/10.3390/idr13010003
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author Teja, Bijan
Alibhai, Nafeesa
Rubenfeld, Gordon D.
Taggart, Linda R.
Jivraj, Naheed
Hirji, Sameer A.
O’Gara, Brian P.
Shaefi, Shahzad
author_facet Teja, Bijan
Alibhai, Nafeesa
Rubenfeld, Gordon D.
Taggart, Linda R.
Jivraj, Naheed
Hirji, Sameer A.
O’Gara, Brian P.
Shaefi, Shahzad
author_sort Teja, Bijan
collection PubMed
description While early empiric antibiotic therapy is beneficial for patients presenting with sepsis, the presentation of sepsis from Clostridioides difficile (formerly Clostridium difficile) infection (CDI) has not been well studied in large cohorts. We sought to determine whether the combination of extreme leukocytosis and diarrhea was strongly predictive of CDI in a cohort of 8659 patients admitted to the intensive care unit. We found that CDI was present in 15.0% (95% CI, 12.1–18.3%) of patients with extreme leukocytosis and diarrhea and that mortality for those with CDI, diarrhea, and extreme leukocytosis was 33.8% (95% CI, 23.2–44.3%). These data support consideration of empiric treatment for CDI in unstable critically ill patients with extreme leukocytosis and diarrhea, along with treatment of other possible sources of sepsis as appropriate. Empiric treatment for CDI can usually be discontinued promptly, along with narrowing of other broad-spectrum antimicrobial coverage, if a sensitive C. difficile test is negative.
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spelling pubmed-78390432021-01-28 Prevalence of Clostridioides difficile Infection in Critically Ill Patients with Extreme Leukocytosis and Diarrhea Teja, Bijan Alibhai, Nafeesa Rubenfeld, Gordon D. Taggart, Linda R. Jivraj, Naheed Hirji, Sameer A. O’Gara, Brian P. Shaefi, Shahzad Infect Dis Rep Article While early empiric antibiotic therapy is beneficial for patients presenting with sepsis, the presentation of sepsis from Clostridioides difficile (formerly Clostridium difficile) infection (CDI) has not been well studied in large cohorts. We sought to determine whether the combination of extreme leukocytosis and diarrhea was strongly predictive of CDI in a cohort of 8659 patients admitted to the intensive care unit. We found that CDI was present in 15.0% (95% CI, 12.1–18.3%) of patients with extreme leukocytosis and diarrhea and that mortality for those with CDI, diarrhea, and extreme leukocytosis was 33.8% (95% CI, 23.2–44.3%). These data support consideration of empiric treatment for CDI in unstable critically ill patients with extreme leukocytosis and diarrhea, along with treatment of other possible sources of sepsis as appropriate. Empiric treatment for CDI can usually be discontinued promptly, along with narrowing of other broad-spectrum antimicrobial coverage, if a sensitive C. difficile test is negative. MDPI 2021-01-01 /pmc/articles/PMC7839043/ /pubmed/33401377 http://dx.doi.org/10.3390/idr13010003 Text en © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Teja, Bijan
Alibhai, Nafeesa
Rubenfeld, Gordon D.
Taggart, Linda R.
Jivraj, Naheed
Hirji, Sameer A.
O’Gara, Brian P.
Shaefi, Shahzad
Prevalence of Clostridioides difficile Infection in Critically Ill Patients with Extreme Leukocytosis and Diarrhea
title Prevalence of Clostridioides difficile Infection in Critically Ill Patients with Extreme Leukocytosis and Diarrhea
title_full Prevalence of Clostridioides difficile Infection in Critically Ill Patients with Extreme Leukocytosis and Diarrhea
title_fullStr Prevalence of Clostridioides difficile Infection in Critically Ill Patients with Extreme Leukocytosis and Diarrhea
title_full_unstemmed Prevalence of Clostridioides difficile Infection in Critically Ill Patients with Extreme Leukocytosis and Diarrhea
title_short Prevalence of Clostridioides difficile Infection in Critically Ill Patients with Extreme Leukocytosis and Diarrhea
title_sort prevalence of clostridioides difficile infection in critically ill patients with extreme leukocytosis and diarrhea
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7839043/
https://www.ncbi.nlm.nih.gov/pubmed/33401377
http://dx.doi.org/10.3390/idr13010003
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