418. Factors Predictive for Severe Clostridium difficile infection (CDI) in the Elderly - A Case-Control Study
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Advanced age is a risk factor for severe CDI. However the factors that predict severe CDI in the elderly are undefined. We performed a matched case-control study of severe CDI in older adults, to determine clinical and laboratory features that predict progression to severe disease.
Methods: A retrospective case-control study was performed of older adults (age≥60 years) with severe CDI, hospitalized at 2 acute-care hospitals at the Detroit Medical Center, between January 2006 to December 2008. All patients with diarrhea and a positive Clostridium difficile toxin assay result on stool specimen were identified from the laboratory database. Case patients were ≥60 years of age and had severe CDI defined as: CDI resulting in admission to an intensive care unit, or colectomy, or death <30 days after onset of CDI. Control group were patients age ≥60 years with non-severe CDI. Patient demographics, co-morbidities and clinical and laboratory features were analyzed. Logistic regression was applied to identify independent predictors of severe CDI.
Results: 18 cases with severe CDI. were identified during the study period and were matched for age with 18 controls with non-severe CDI. Two case patients underwent colectomy,11 were admitted to ICU for CDI and 15 died from complications related to CDI.
CharacteristicCases (N=18)Controls (N=18)P value
Mean Age (years)75.3 +/- 8.778.7 +- 7.4
Female gender11 (61.1%)5 (72.2%)
Charlson’s score2.53.00.47
Abdominal pain10(55.6%)2(11.1%)0.01
Abdominal distension11 (61.1%)1(5.5%)<0.001
WBC23.3 +/- 11.716.0 +/-13.70.09
Low Albumin15( 100%)10(71.4%)0.04
Renal Faliure9 (53%)4 (22.2%)0.08
Ileus on abdominal Xray7(38.9%)1(5.6%)0.04

Regression modeling identified the following characteristics at initial presentation to be predictive of severe CDI: presence of abdominal pain (Odds ratio(OR)=10,95% CI=1.75-56.5) and intestinal ileus on abdominal radiograph (OR=10.8,95% CI=1.16-100.4).
Conclusion: Abdominal pain and ileus at initial presentation are significant predictors of progression to severe CDI in hospitalized older adults.
George Alangaden, MD1, Teena Chopra, MD2, Keith Kaye, MD, MPH, FIDSA, FSHEA3, Jasdeepa Nagi, MD2 and  J. Nagi, None..
T. Chopra, None..
K. Kaye, None..
G. Alangaden, None., (1)Detroit Medical Center/Wayne State University, Detroit, MI, (2)Detroit Medical Center, Detroit, MI, (3)Detroit Medical Center, Wayne State University, Detroit, MI