difficile was 8.0 days �� 9.3 days, P = 0.4.Moreover, the median length of ICU stay in the whole population was 4 (3 to 9) days, whereas the median length of ICU stay in the ICU-acquired CDI group was 20 (12 to 42) days. The estimated prolongation of ICU stay due www.selleckchem.com/products/kpt-330.html to C. difficile was 6.3 days �� 4.3, P = 0.14DiscussionIn our retrospective study conducted in an ICU cohort population, we found that ICU- and hospital crude mortality of CDI patients were 21 and 34%, respectively. Despite a significantly higher crude mortality, when using modern statistical models, CDI was not associated with increased mortality, regardless of the control groups, and after careful adjustment on confounding factors of mortality and on other adverse events and nosocomial infections associated with mortality.

The crude mortality rate associated with ICU-acquired CDI that we observed is similar to that observed in previous studies conducted elsewhere [7,8,21-23]. It is also notable that, even if the duration of ICU stay of CDI patients was considerably longer than that of other mechanically ventilated patients, the extra-length of stay that we estimated using a multistate model was 6.3 days and did not reach a statistical significance (P = 0.14).Treatment of CDI occurred after a median delay of one day after diagnostic test sampling. The early treatment of patients probably explains the lack of significant impact on mortality.Our results are in contradiction with previous studies conducted in ICUs that have found a higher mortality of patients with ICU-acquired CDI. Ang et al.

found a higher crude ICU mortality of 33.9% in ICU acquired CDI as compared to other ICU patients (29%) [7]. Using a matched case-control design, Kenneally et al. [8] found the overall 30-day mortality rate in a cohort of 278 ICU patients with CDI equaled 36.7%, giving a 6.1% (95% CI, -1.7% to 13.9%, P = 0.127) CDI-attributable mortality rate. However, they did not adjust for confounding variables, such as severity of disease or other adverse events. Another study reported by Lawrence et al. [21] identified 40 ICU-acquired CDI in a 19-bed medical ICU during a 30-month period. Using univariate analysis, CDI neither influenced ICU- (CDI 18 vs. other 20%) nor hospital mortality (CDI 30% vs. other 28%), but was associated with an increase in the crude length of ICU- (CDI 15 days vs. other 3 days, P < 0.

001) and hospital stay (CDI 38 vs. other 10 days, P < 0.001). After adjustment for severity of the acute illness, vancomycin resistant enterococcus (VRE) colonization, receipt of antimicrobial AV-951 and occurrence of nosocomial infection, but without taking into account ICU time before CDI acquisition, CDI was associated with a longer ICU length of stay (OR, 1.24 (95% CI, 1.07 to 1.44)).There are a number of potential reasons why studies have shown variable association with CDI and mortality.