(396) Evaluation of Nutrition Therapy in Critically Ill Patients With Clostridioides difficile Infection

Introduction: Nutrition therapy in the intensive care unit (ICU) is a fundamental aspect of care. However, there is minimal guidance on nutrition therapy in critically ill patients with Clostridioides difficile infection (CDI) despite the potentially severe consequences of this infection on the gastrointestinal tract. The purpose of this study was to evaluate nutrition therapy in critically ill patients with known CDI compared to nutrition therapy in critically ill patients with other infections.

Methods: This was a single-center, retrospective cohort study of patients admitted to the ICU from January 1, 2013 through December 31, 2022. This study compared nutrition therapy in critically ill patients who had CDI compared to a matched cohort of critically ill patients who had diagnoses of other infections. Outcomes included nutrition route, dose of nutrition prescribed, need for nutrition support, ICU length of stay and mortality. Safety outcomes included measures of nutrition tolerance such as abdominal distention, aspiration, ileus, and need for nasogastric decompression.

Results: A total of 66 patients were included in this study, 33 in each group. In the CDI group, 25 patients (75.8%) required nutrition support compared to 16 patients (48.5%) in the control group (p=0.04). In the CDI group, the median duration of ICU stay was 11 days compared to six days in the control group (p < 0.01). There were no statistically significant differences in the median number of days NPO, number of days receiving full meals, the median maximum calories received, or need for parenteral nutrition. Measures of feeding safety and tolerance, including abdominal distension, aspiration, ileus, and need for nasogastric decompression, were similar among both groups.

Conclusions: Although patients with CDI had higher use of nutrition support therapy and longer ICU stays, significant differences were not found in most important measures of nutrition provision. Further, the similar proportions of feeding intolerance and need for parenteral nutrition suggests that feeding by the oral or enteral route is as safe in patients with CDI as in other critically ill patients. These results may aid clinicians in the management of nutrition therapy for those with CDI and help generate hypotheses for further study.