Can we improve the therapy of Clostridium difficile infection in elderly patients?

BACKGROUND: Clostridium difficile infection (CDI) is becoming a serious problem predominantly in geriatric patients, who are a significant risk group. The goal of this study was to evaluate the risk factors for mortality in CDI patients and to construct a binary logistic regression model that describes the probability of mortality in geriatric patients suffering from CDI. METHODS: In this retrospective study, we evaluated a group of 235 patients over 65 years of age with confirmed diagnoses of CDI, hospitalized at the Department of Internal Medicine, Geriatrics and General Practice, Brno, from January 2008 to December 2013. The examined group comprised 148 women (63 %) and 87 men (37 %). For the diagnosis of CDI, confirmation of A and B toxins in the patients' stool or an autopsy confirmation was crucial. RESULTS: The impact of antibiotic therapy on the increased incidence of CDI was clearly confirmed in our study group when examining patients' histories. Other risk factors included cerebrovascular disease, dementia, the presence of pressure ulcers, and immobility. Our new model consisted of a combination of the following parameters: the number of antibiotics used (from patients' history), nutritional status (Mini Nutritional Assessment short-form test), presence of pressure ulcers, and occurrence of fever. CONCLUSION: Our logistic regression model may predict mortality in geriatric patients suffering from CDI. This could help improve the therapeutic process.

[The disease caused by Clostridium difficile in geriatric patients]. / Onemocnení vyvolané Clostridium difficile u geriatrických nemocných.

BACKGROUND: The disease caused by the bacterium Clostridium difficile/Clostridium difficile associated disease/diarrhoea (CDAD) is becoming a serious problem especially in geriatric patients, who are now relatively often treated by broad-spectrum antibiotics. The goal of our study was to evaluate the occurrence of the risk factors and to evaluate the complex of relations and coherence which lead to the CDAD disease in a selected group of seniors treated at our institution. MATERIAL AND METHODS: The retrospective study evaluated a group of 67 patients with diagnosed CDAD, who were hospitalized at the clinic of internal medicine, geriatrics and practical medicine, Faculty of Medicine and Faculty Hospital in Brno from January 2007 till October 2010. In the study 46 women (68.7%) and 21 men (31.3%) were included of the average age 78.8 +/- 10.3 years (56 till 96 years). The decisive moment in the diagnosis of CDAD was the discovery of enterotoxines A and B in faeces of the patients. RESULTS: The mean time of hospitalization of the patients suffering from CDAD was significantly higher (p = 0.01) in comparison with the control patients (24.63 +/- 16.34 vs. 11.5 +/- 10.7 days). Polymorbidity was also high in those patients. On average, each patient was ill with 11.3 diseases. The most frequent diseases were: high blood pressure (76.1% of the patients), ischemic heart disease 68.7% and the third most frequent diagnosis was the cerebrovascular disease 50.7%. We found that only 13 patients (19.4%) did not take the antibiotics at all, further 54 patients (80.6%) used one or more antibiotics. From the cohort of 67 patients 12 died (17.9%), the section was done in 7 patients, and colitis pseudomembranosa was proved in 3 of them. In 8 cases relapse of the colitis was proved. CONCLUSIONS: The infection of the clostridium is a very serious disease which increases the morbidity and mortality in geriatric patients. Besides the demands on the diagnostics and therapy, it influences also the duration of the hospitalization.