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Critical Care

Open Access

Clostridium difficile infection in ICU patients

  • E Belesiotou1,
  • C Routsi1,
  • M Nepka1,
  • E Magira1,
  • P Kaltsas1,
  • Z Psaroudaki1,
  • E Kraniotaki1,
  • A Argyropoulou1,
  • T Pittaras1 and
  • S Zakynthinos1
Critical Care201418(Suppl 1):P344

Published: 17 March 2014


Clostridium difficile infection is becoming more common worldwide. Critically ill patients are at particularly high risk for this disease due to multiple risk factors in this population. Accurate diagnosis is essential for patient management, infection control and epidemiology. There are a variety of methods to detect the presence of toxigenic C. difficile in stools [1],[2]. The aim of this study was to evaluate the incidence of C. difficile infection in our ICU. Laboratory results of C. difficile toxin detection performed by the methods available in our institution are presented.


During the last year, all stool specimens received in the microbiology department from patients hospitalized in the 30-bed, multidisciplinary ICU of a tertiary-care hospital were evaluated. Specimens were ordered by physicians in the presence of clinical features compatible with C. difficile-associated infection. Each specimen was subjected to diagnostic tests for C. difficile infection including toxin enzyme immunoassays for C. difficile toxins A and B detection (DUO Toxin A&B; VEDA.LAB, France), and glutamate dehydrogenase (GDH) for cell wall antigen detection (C. DIFF Quik Chek Complete®; USA).


During the study period, 335 stool specimens were evaluated. Results obtained with the two-stage immunoassay tests are shown in Figure 1. All infected patients were treated with metronidazole or vancomycin. Following a course of therapy, 2% of the infected patients had recurrence or relapse. The crude mortality rate was 17%.
Figure 1

Illustration of the tests performed for detection of C. difficile.


GDH antigen was positive in 12% of the stool specimens received from ICU patients with suspected C. difficile -associated infections. The majority of these specimens (51.4%) produce both C. difficile toxins A and B, whereas toxin B is produced in 31.4% and toxin A in the remaining 17.2%.

Authors’ Affiliations

Evangelismos Hospital, Athens, Greece


  1. Bobo LB, et al: Chest. 2011, 140: 1643-10.1378/chest.11-0556.PubMed CentralView ArticlePubMedGoogle Scholar
  2. Cohen SH, et al: Infect Control Clin Epidemiol. 2010, 315: 431-View ArticleGoogle Scholar


© Belesiotou et al.; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2014 and co-published as a series in Critical Care. Other articles in the series can be found online at Further information about the Annual Update in Intensive Care and Emergency Medicine is available from