Background: Advancing age is a risk factor for acquiring Clostridium difficile infection (CDI), which is associated with substantial morbidity and mortality. However, few studies have focused on the epidemiology of CDI and its clinical outcomes among elderly patients. This is the first study to investigate clinical characteristics and outcomes of CDI in the Japanese elderly (age ≥70).
Methods: We conducted a retrospective multicenter study on clinical characteristics and outcomes of CDI patients admitted to 4 Japanese teaching hospitals from April 2012 to October 2013. Since a commercial diagnostic polymerase chain reaction test was unavailable to us, CDI was diagnosed by an infectious disease physician based on clinical manifestation and toxin detection in an enzyme immunoassay. Univariate analyses were performed assess characteristics and outcomes (90-day mortality and recurrence) of elderly patients. Categorical and continuous variables were assessed using the Fisher's exact and Mann-Whitney U tests, respectively. Multivariate logistic regression analysis was performed for 90-day mortality and recurrence as dependent variables. Two-tailed p < 0.05 was considered significant.
Results: Among 170 CDI patients, 83 (48.5%) were classified as the elderly group (mean age 77.5 ± 6.0 years), of which, 13 (15.7%) experienced recurrent CDI, with a 90-day mortality rate of 34.9%. In multivariate analysis, malignancy (odds ratio [OR] 5.19, 95% confidence interval [CI] 1.15–23.30; p = 0.032) and hypoalbuminemia (OR 9.62, 95% CI 1.31–70.70; p = 0.026) were associated with 90-day mortality, whereas hypotension (OR 5.96, 95% CI, 1.23–29.00; p = 0.027) was associated with recurrence.
Conclusion: Hypoalbuminemia, malignancy, and hypotension were associated with a poor prognosis in the elderly group. Better understanding of CDI epidemiology and improvements in determining and predicting its severity and prognosis are needed to reduce CDI burden among the elderly.
K. Kobayashi, None
N. Sekiya, None
H. Kurai, None
A. Imamura, None
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