Nosocomial Clostridium difficile Infection among Patients Over 90 Years Old

Abstract

Aim: Ageing population trends indicate that the median life expectancy in Japan is increasing. Clostridium difficile infection (CDI) can be a fatal nosocomial infection among the geriatric population. We examined clinical outcome and risk factors associated with death due to CDI among patients >90 years old. Methods: This retrospective observational study was performed to demonstrate the clinical characteristics of Patients >90 years who developed CDI between April 2010 and March 2015 at Tama-Hokubu Medical Center (a 344-bed community tertiary care hospital; average age of inpatients: 72 years). Diagnosis of CDI was confirmed via an enzyme-linked immunosorbent assay using stool sample. Multivariate analysis was performed to determine the independent risk factors associated with death. Results: Twenty-nine patients with CDI confirmed were identified. The mean age was 93 (90–100) years and 37.9% were women. Patients presented with hypertension (37.9%) and diabetes (33%) as underlying diseases, and 93.1% were admitted from long-term care facilities. The median period from admission to onset of CDI was 14 (2– 73) days. The average episodes of diarrhea was 3.96 (1 to 10) times per day. The overall 90-day mortality rate was 34.5%. Multivariate analysis revealed that arrhythmia followed by onset of CDI (Odds Ratio, 8.0; 95% Confidence Interval, 1.37–46.8; P=0.021) was an independent risk factor associated with death. Conclusions: Arrhythmia followed by onset of CDI is a risk factor for death. Strict clinical management, including continuous monitoring of electrolyte and fluid balance and careful observation of patients >90 years old is crucial.