Predictors of Clostridium difficile infection-related mortality among older adults

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• 作者：Teena Chopra ; MD ; MPH^a ; Reda A. Awali ; MD ; MPH^a ; ^{rawali@med.wayne.edu" class="auth_mail" title="E-mail the corresponding author} ; Caitlin Biedron ; MD^a ; Eileen Vallin ; BA^a ; Suchitha Bheemreddy ; MD^a ; Christopher M. Saddler ; MD^a ; Keith Mullins ; BS^a ; Jose F. Echaiz ; MD^b ; Luigino Bernabela ; MD^a ; Richard Severson ; PhD^c ; Dror Marchaim ; MD^d ; ^e ; Paul Lephart ; PhD^a ; Laura Johnson ; MD^b ; Rama Thyagarajan ; MD^f ; Keith S. Kaye ; MD ; MPH^a ; George Alangaden ; MD^b
• 关键词：Clostridium difficile ; older adults ; mortality
• 刊名：American Journal of Infection Control
• 出版年：2016
• 出版时间：1 November 2016
• 年：2016
• 卷：44
• 期：11
• 页码：1219-1223
• 全文大小：226 K

文摘

Over 90% of annual deaths caused by Clostridium difficile infection (CDI) occur in persons aged ≥65 years. However, no large-scale studies have been conducted to investigate predictors of CDI-related mortality among older adults.

Methods

This case-control study included 540 CDI patients aged ≥60 years admitted to a tertiary care hospital in Detroit, Michigan, between January 2005 and December 2012. Cases were CDI patients who died within 30 days of CDI date. Controls were CDI patients who survived >30 days after CDI date. Cases were matched to controls on a 1:3 ratio based on age and hospital acquisition of CDI.

Results

One-hundred and thirty cases (25%) were compared with 405 controls (75%). Independent predictors of CDI-related mortality included admission from another acute hospital (odds ratio [OR], 8.25; P = .001) or a long-term care facility (OR, 13.12; P = .012), McCabe score ≥2 (OR, 12.19; P < .001), and high serum creatinine (≥1.7 mg/dL) (OR, 3.43; P = .021). The regression model was adjusted for the confounding effect of limited activity of daily living score, total number of antibiotic days prior to CDI, ileus on abdominal radiograph, low albumin (≤2.5 g/dL), elevated white blood cell count (>15 × 1,000/mm³), and admission to intensive care unit because of CDI.

Conclusions

Predictors of CDI-related mortality reported in this study could be applied to the development of a bedside scoring system for older adults with CDI.