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Clostridioides difficile infection in neurosurgical patients in a national centre over 10 years: less common but associated with longer hospital stays

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Abstract

Background

Clostridioides difficile infection (CDI) is a leading cause of healthcare-associated (HA) diarrhoea, contributing to patient morbidity and prolonged length-of-stay (LOS). We retrospectively assessed CDI over a decade in a national neurosurgical centre, with a multi-disciplinary approach to CDI surveillance and antimicrobial stewardship, by comparing CDI patients with other patient groups.

Methods

Data on CDI in neurosurgical inpatients between January 2012 and December 2021 were collated. Disease-specific variables were compared to other inpatients with CDI. Rates per 10,000 bed days used were calculated. Patient-specific differences were compared with neurosurgical patients without CDI. CDI rates by patient group were explored using odds ratio (OR) and χ2 analyses. Negative binomial regression was used to investigate CDI rates over time.

Results

Of 50 neurosurgical patients with CDI, all were HA; the average age was 53 years (standard deviation (SD) 16.3 years), 49 were first-episode CDI, and three had severe CDI. The majority (76.7%) had received recent antimicrobials. Compared with non-neurosurgical CDI patients, neurosurgical CDI rates differed significantly (1.9 versus 3.6 per 10,000 bed days used, p < 0.05), neurosurgical patients were younger (p ≤ 0.01), C. difficile testing was more likely to be requested by neurosurgeons (OR 2.4; p ≤ 0.01), and the proportion of severe CDI was higher (6% versus 2%, OR 3.0, p = 0.07, confidence interval (CI) 0.54 to 11.3). Within the neurosurgical cohort, CDI patients had an average LOS four times that of other patients (CI 15.2 to 35.1; p < 0.01) and were older (53.5 versus 47.8 years, CI 0.1 to 11 years; p < 0.05). Only one CDI outbreak was linked to neurosurgical patients.

Conclusion

CDI in neurosurgery patients differed from the wider hospital, with greater awareness of CDI testing. Longer LOS impacted bed utilisation with limited capacity. Robust surveillance supports proactive antimicrobial stewardship programmes in this vulnerable population.

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Data availability

All data used in this study has been stored as per ethics approval by the Beaumont Hospital Ethics Committee (REC reference 19/33).

Code availability

Not applicable.

Abbreviations

BDU:

Bed days used

CA:

Community-associated

CI:

Confidence interval

CDI:

Clostridioides difficile infection

EVD:

External ventricular drain

HA:

Healthcare-associated

IQR:

Interquartile range

IPC:

Infection prevention and control

LOS:

Length of stay

MDT:

Multi-disciplinary team

N-ICU:

Neurosurgical intensive care unit

OR:

Odds ratio

RT:

Ribotype

SD:

Standard deviation

SAH:

Subarachnoid haemorrhage

SAP:

Surgical antimicrobial prophylaxis

UTI:

Urinary tract infection

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Acknowledgements

We are grateful for the assistance of Nora Hourigan, Business Intelligence Manager, and staff in Management Information; Paula Corr, Clinical Nurse Manager, Neurosurgery Research and Audit; and finally, the staff of the Microbiology, Infection Prevention and Control, and Neurosurgery Departments.

Funding

MS is supported by the Irish Research Council as part of the Employment-Based Postgraduate Programme (EBPPG/2022/196).

Author information

Authors and Affiliations

  1. Department of Microbiology, Beaumont Hospital, Dublin 9, Ireland

    Mairead Skally, Maeve Leonard, Karen Burns, Binu Dinesh & Fidelma Fitzpatrick

  2. Department of Clinical Microbiology, The Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland

    Mairead Skally, Karen Burns, Binu Dinesh, Hilary Humphreys & Fidelma Fitzpatrick

  3. European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Clostridioides difficile – ESGCD, Basel, Switzerland

    Mairead Skally & Fidelma Fitzpatrick

  4. Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, United Kingdom

    Philip J. O’Halloran

  5. Department of Physiology & Medical Physics, RCSI University of Medicine and Health Sciences, Dublin, Ireland

    Philip J. O’Halloran

  6. Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland

    Ben Husien

  7. Data Sciences Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland

    Kathleen Bennett

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  1. Mairead Skally
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Contributions

MS and FF contributed to the study conception and design. Material preparation, data collection and analysis were performed by MS. The first draft of the manuscript was written by FF and ML, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mairead Skally.

Ethics declarations

Ethics approval

The study was approved by the Beaumont Hospital Ethics Committee (REC reference 19/33).

Consent to participate

Not applicable as all data used in this research was retrospective and fully anonymised at source.

Consent for publication

Not applicable as all data used in this research was retrospective and fully anonymised at source.

Competing interests

HH has received research grants from Pfizer and has advised the Scottish Hospitals Inquiry and the Bons Secours Hospital Group (Ireland) on infection prevention and control issues. FF has received research grant support and been a recipient of a consultancy fee from Tillotts Pharma.

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Skally, M., Leonard, M., O’Halloran, P.J. et al. Clostridioides difficile infection in neurosurgical patients in a national centre over 10 years: less common but associated with longer hospital stays. Acta Neurochir 165, 3585–3592 (2023). https://doi.org/10.1007/s00701-023-05883-1

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