429. Rapidly Fatal Clostridium difficile Infections in the Elderly: A Report of 38 Cases
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A

Background: Increasing incidence, morbidity and mortality from the epidemic C difficile (BI/NAP1/027) infection (CDI) have been reported recently. The elderly has repeatedly been observed to be at risk for severe disease and death. We describe the clinical features of patients who died with CDI in a community hospital.
Methods: Medical records of patients who died with CDI from Jan 2007 to Dec 2008 were reviewed as part of an IRB approved surveillance study. Demographic, clinical and laboratory data were extracted and analyzed using SPSS version 17.
Results: Nineteen of 86 (22%) and 19 of 118 (16%) admitted cases in 2007 and 2008, respectively, resulted in death. The median age of the patients was 83.5 years. Thirty six had history of antibiotic use, most commonly-cephalosporins, quinolones or broad-spectrum penicillins. All cases had either recent history of hospitalization or residence in long term care facility. Most were diagnosed either as an outpatient (16%) or within 72 hours of admission (79%). Twenty one (55%) never had history of CDI. Sepsis, severe sepsis and shock were present on admission in 71%, 50% and 21%, respectively, and did not correlate with the presence of another infection or bacteremia. Dehydration was noted in 58%. Leukocytosis of > 20,000 developed in 53%. Sixty five % had albumin level < 2 mg/dl. Colitis was reported in 22% and 67% of those who had abdominal film and CT, respectively. The mean number of days from onset of symptoms to diagnosis and from diagnosis to admission, treatment or vancomycin administration was 3 ± 3.7 (SD) and 1.2 ± 1.5, 1.4 ± 1.2 or 2 ± 2.3, respectively, for patients with first episode of CDI. CDI alone was the cause of death in 53% and was associated with another potential cause in 39.5%. Median length of hospital stay was 5 days with 29% of all deaths occurring within the first 2 days of admission.
Conclusion: The elderly patients are especially prone to rapidly fatal CDI despite adequate medical treatment. Specific management strategies and further research addressing CDI in this vulnerable population are urgently needed.
William Cohee, PharmD1, Andrea Fountain, BA1, Clinton Merritt, MD1, Carolyn Palmer, BSN1, Cirle Warren, MD2 and  C. A. Warren, None..
C. H. Palmer, None..
A. L. Fountain, None..
W. R. Cohee, None..
C. T. Merritt, None., (1)Augusta Medical Center, Fishersville, VA, (2)University of Virginia, Charlottesville, VA