Co-morbidity, not age predicts adverse outcome in clostridium difficile colitis.

Abstract

AIM:To examine whether age alone or co-morbidity is a risk factor for death in older adults who developed Clostridium difficile (Cd) colitis during hospitalization.METHODS:A retrospective, observational study design was performed in our Lady of Mercy Medical Center,a 650-bed, urban, community-based, university-affiliated teaching hospital. 121 patients with a positive diagnosis of Cd colitis (aged 23-97 years) were studied, and data pertinent to demographic variables, medical history, co-morbidity, physical examination,and laboratory results were collected.Age was examined as a continuous variable and stratified into Age1 (< 80 vs 80+); Age2 (< 60, 60-69, 70-79 and 80+); or Age3 (< 60, 60-69, 70-79, 80-89,90+).RESULTS:Cd colitis occurs more frequently with advancing age (55% of cases > 80 years). However, age,per se,had no effect on mortality. A history of cardiac disease (P = 0.036), recurrent or refractory infection > 4 weeks (P=0.007),low serum total protein (P= 0.034), low serum albumin (P = 0.001), antibiotic use > 4 weeks (P<0.010), use of over 4 antibiotics (P=0.026), and use of certain classes of antibiotics (P=0.035-0.004) were predictive of death. Death was strongly predicted by the use of penicillin-like-antibiotics plus clindamy-cin, in the presence of hypoalbuminemia,refractory sepsis, and cardiac disease (P=0.00005).CONCLUSION:Cdcolitis is common in the very old.However, unlike co-morbidity,age alone does not affect the clinical outcome (survival vs death).