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Friday, March 19, 2010
Grand Hall (Hyatt Regency Atlanta)
Background: CDI is particularly common in older adults. However, comparison of the risk factors and outcomes of CO-CDI and HO-CDI in the elderly has not been previously evaluated.
Objective: To study and compare the epidemiology of HO-CDI and CO-CDI.
Methods: A case-control study was performed of older adults (age≥60 years) with CDI, hospitalized at 3 acute- care hospitals at the Detroit Medical Center, between January 2005 and December 2008. All patients with diarrhea and a positive Clostridium difficile toxin assay result on stool specimen were identified from the laboratory database. Case patients were ≥60 years of age and had HO-CDI, defined as: CDI onset occurring after 48 hours of admission. Control group were patients age ≥60 years with CO-CDI, defined as CDI onset within 48 hours of admission. Patient variables collected included demographics, comorbidities, functional status, and development of severe CDI (CDI resulting in admission to an intensive care unit, or colectomy, or death <30 days after onset of CDI). Logistic regression was applied to identify risk factors of HO and CO-CDI and independent predictors of progression to severe CDI.
Results: 126 HO-CDI cases and 77 CO-CDI controls were analyzed. The baseline demographics in the two groups were comparable .The mean age of all patients was 74.4 years; 61% were female and 77% were African-American. 99(78.5 %) of cases and 55 (71.4%) of controls had a Charlson’s score >3. A rapidly fatal condition was present in 18(14.3%) of HO-CDI and 8(10.4%) of CO-CDI at admission. Impaired functional status (ADL > 3) was reported in 66(52.4%) of HO-CDI and 24(31.2%) of CO-CDI at admission(p=0.003). Epidemiology of CO-CDI and HO-CDI was similar. However independent variables associated with developing HO-CDI on multivariate analysis included GI procedure in 60 days prior to CDI (OR=2.54, 95% CI=1.15~5.62), any surgery in 60 days prior to CDI (OR=2.00, 95% CI=1.02~3.91) and impaired functional status at admission (requiring assistance with > 3 ADLs) (OR=2.46, 95% CI= 1.34~4.53). 18(14.3%) HO-CDI and 17 (22%) CO-CDI patients developed severe CDI (p value=0.1). After controlling for impaired functional status (ADL>3), severe CDI was more common in CO-CDI (OR=0.52, 95% CI=0.24~1.12).
Objective: To study and compare the epidemiology of HO-CDI and CO-CDI.
Methods: A case-control study was performed of older adults (age≥60 years) with CDI, hospitalized at 3 acute- care hospitals at the Detroit Medical Center, between January 2005 and December 2008. All patients with diarrhea and a positive Clostridium difficile toxin assay result on stool specimen were identified from the laboratory database. Case patients were ≥60 years of age and had HO-CDI, defined as: CDI onset occurring after 48 hours of admission. Control group were patients age ≥60 years with CO-CDI, defined as CDI onset within 48 hours of admission. Patient variables collected included demographics, comorbidities, functional status, and development of severe CDI (CDI resulting in admission to an intensive care unit, or colectomy, or death <30 days after onset of CDI). Logistic regression was applied to identify risk factors of HO and CO-CDI and independent predictors of progression to severe CDI.
Results: 126 HO-CDI cases and 77 CO-CDI controls were analyzed. The baseline demographics in the two groups were comparable .The mean age of all patients was 74.4 years; 61% were female and 77% were African-American. 99(78.5 %) of cases and 55 (71.4%) of controls had a Charlson’s score >3. A rapidly fatal condition was present in 18(14.3%) of HO-CDI and 8(10.4%) of CO-CDI at admission. Impaired functional status (ADL > 3) was reported in 66(52.4%) of HO-CDI and 24(31.2%) of CO-CDI at admission(p=0.003). Epidemiology of CO-CDI and HO-CDI was similar. However independent variables associated with developing HO-CDI on multivariate analysis included GI procedure in 60 days prior to CDI (OR=2.54, 95% CI=1.15~5.62), any surgery in 60 days prior to CDI (OR=2.00, 95% CI=1.02~3.91) and impaired functional status at admission (requiring assistance with > 3 ADLs) (OR=2.46, 95% CI= 1.34~4.53). 18(14.3%) HO-CDI and 17 (22%) CO-CDI patients developed severe CDI (p value=0.1). After controlling for impaired functional status (ADL>3), severe CDI was more common in CO-CDI (OR=0.52, 95% CI=0.24~1.12).
Conclusions: Even though HO-CDI patients had a higher severity of illness on admission as compared to CO-CDI patients, progression to severe CDI was more common in CO-CDI patients.