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C. difficile infection in elderly may raise mortality, morbidity risk

Roshini Claire Anthony
11 Jan 2019

Elderly individuals with a Clostridium difficile (C. difficile) infection have a higher risk of 30-day mortality and admission to long- or short-term facilities compared with their counterparts without C. difficile infection, a recent study showed.

Researchers of this retrospective study used medical claims records from 2010–2012 to identify 174,903 elderly patients with C. difficile infection in 2011 and compared them with 1,318,538 elderly individuals without the infection (mean age 77.5 years, 62.0 percent female, 87.1 percent Caucasian).

Elderly patients with C. difficile infection had an elevated risk of 30-day all-cause mortality compared with those without C. difficile infection (odds ratio [OR], 1.77, 95 percent confidence interval [CI], 1.74–1.81), with a 10.9 percent excess risk over patients without the infection. [Infect Control Hosp Epidemiol 2019;40:65-71]

“[T]he risk of mortality was highest in persons with [the] lowest probability of C. difficile infection [hazard ratio [HR], 3.04, 95 percent CI, 2.83–3.26], with progressively decreased risk of mortality as the probability of C. difficile infection increased,” said the researchers. “In contrast, patients in the lowest baseline C. difficile infection stratum had a threefold increased risk of 1-year all-cause mortality if they developed C. difficile infection.”

These findings could be due to the “very high underlying severity of illness” among patients with a very high risk of developing C. difficile infection, they explained.

The risk of new admission to a long-term care facility within 30 days was also increased by 2.7 percent among elderly patients with C. difficile infection (OR, 1.74, 95 percent CI, 1.67–1.82), as was the risk of new admission to a short-term skilled nursing facility (15.8 percent increase; OR, 2.52, 95 percent CI, 2.46–2.58) compared with patients without C. difficile infection.

C. difficile infection was also associated with an elevated risk for hospitalization at 30 days (HR, 2.27, 95 percent CI, 2.22–2.32), 90 days (HR, 1.95, 95 percent CI, 1.92–1.98), and 1 year (HR, 1.52, 95 percent CI, 1.51–1.54).

“The increased risk of 30-day … admission [to a short-term skilled nursing facility] is suggestive of acute C. difficile infection-attributable morbidity and is further supported by the increased risk of 30- and 90-day hospitalizations in … patients with [C. difficile infection, while] the increased risk of … transfer [to a long-term care facility] suggests that C. difficile infection also contributes to chronic morbidity from which patients are unable to fully recover,” said the researchers, pointing out that the elevated risk of admission to a long-term facility also has an impact on quality of life and finances.

“Our findings suggest that C. difficile infection prevention strategies should not be limited to just high-risk populations; lower-risk elderly populations may have the greatest benefit,” they added, highlighting the need for novel strategies to prevent C. difficile infection in the elderly population.

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