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Does accepted definition of Clostridioides difficile infection (CDI) severity predict poor outcomes in older adults?

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Abstract

Background

Advanced age is an important factor affecting Clostridioides difficile infection (CDI) risk and outcome. While fever and leukocytosis are prominent findings in young individuals with CDI, they are usually blunted in the elderly. Furthermore, chronic kidney disease often exists among this population prior to the CDI episode onset.

Aim

We aimed to examine whether the accepted definition of severe CDI (leukocytosis ≥ 15,000 cells/μl or serum creatinine > 1.5 mg/dl) predicts poor outcomes in the elderly.

Methods

All CDI hospitalized individuals between January-2013 and May-2020 were included. The study population was dichotomized into older group (≥ 65 years) and younger group (< 65 years). Primary composite outcome was 30-day mortality, colectomy due to severe colitis, or intensive care unit admission. The older group was divided according to the primary outcome to evaluate the effect of CDI severity criteria.

Results

The study included 853 patients. Of them, 571 were in the older group and 282 in the younger one. The primary outcome was significantly more common in the older group (93/571, 16% vs. 31/282, 11%; p = 0.04). Ninety days mortality was significantly higher in the older group [116/571, 20% vs. 30/282, 11%; p < 0.01]. In multivariate analysis, accepted CDI severity criteria were not significantly associated with poor outcomes (odds ratio [OR] = 1.2, 95% confidence interval [CI] 0.7–2.2, p = 0.5). Advanced dementia and low serum albumin were significant predictors of poor outcomes (OR = 3, 95%CI 1.5–6, p = 0.002 and OR = 3.1, 95%CI 1.7–5.8, p < 0.01).

Conclusion

The accepted definition of CDI severity was not useful in predicting CDI poor outcomes in older adults. In this population, we suggest advanced dementia and low albumin among others as CDI severity markers.

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Data and materials are available.

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Funding

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Author information

Authors and Affiliations

  1. Infectious Disease Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel

    Alaa Atamna, Ili Margalit, Dafna Yahav & Jihad Bishara

  2. Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel

    Alaa Atamna, Tanya Babich, Ili Margalit, Tomer Avni, Haim Ben Zvi, Noa-Eliakim Raz, Dafna Yahav & Jihad Bishara

  3. Internal Medicine Department E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel

    Tanya Babich, Tomer Avni & Noa-Eliakim Raz

  4. Internal Medicine Department A, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel

    Tanya Babich, Tomer Avni & Noa-Eliakim Raz

  5. Clinical Microbiology Laboratory, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel

    Haim Ben Zvi

Authors
  1. Alaa Atamna
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  2. Tanya Babich
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  3. Ili Margalit
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  4. Tomer Avni
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  6. Noa-Eliakim Raz
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  7. Dafna Yahav
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  8. Jihad Bishara
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Contributions

Study concept and design: AA, BJ contributed to study conception and design; acquisition, analysis or interpretation of data: all authors; drafting the manuscript: AA drafts the manuscript; critical revision of the manuscript for important intellectual content: all authors.

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Correspondence to Alaa Atamna.

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The authors declare that they have no conflict of interest.

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The study protocol was approved by the hospital ethics committee.

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This article does not contain any studies directly involving human participants, as it is a review of data already collected in an electronic database.

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Atamna, A., Babich, T., Margalit, I. et al. Does accepted definition of Clostridioides difficile infection (CDI) severity predict poor outcomes in older adults?. Aging Clin Exp Res 34, 583–589 (2022). https://doi.org/10.1007/s40520-021-01953-5

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  • DOI: https://doi.org/10.1007/s40520-021-01953-5

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