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179 Predictors of Recurrent Clostridium difficile Infection (CDI) in Older Adults –A Multicenter Case-Control Study

Saturday, April 2, 2011
Trinity Ballroom (Hilton Anatole)
Teena Chopra, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Christopher Saddler, BS , Wayne State University, Detroit, MI
Suchitha Bheemreddy, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Smitha Sathyaprakash, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Jose F. Echaiz, MD , Henry Ford Hospital, Detroit, MI
Laura Johnson, MD , Henry Ford Hospital, Detroit, MI
Richard Severson, PhD , Wayne State University, Detroit, MI
Rama Thyagarajan, MD , Oakwood Health Care System, Dearborn, MI
Keith Mullins, BS , Wayne State University, Detroit, MI
Anthony J. Perissinotti, PharmD , Detroit Medical Center, Wayne State University, Detroit, MI
Gagandeep Cheema, BS , Wayne State University, Detroit, MI
Nena Auraha, BS , Wayne State University, Detroit, MI
Dror Marchaim, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Sorabh Dhar, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Keith S. Kaye, MD, MPH , Detroit Medical Center, Wayne State University, Detroit, MI
George Alangaden, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Background: Advanced age is a known risk factor for recurrent CDI, however, there is limited data on risk factors and epidemiology of recurrent CDI in older adults.

Objective: To characterize the epidemiology of recurrent CDI in older adults at 4 acute care hospitals in South East Michigan.

Methods: A retrospective study was performed on elderly patients aged >60 yr with CDI. Data was collected from 4 acute care hospitals in Southeast Michigan between January 2005 and December 2008. CDI was defined as a patient with diarrhea and a positive stool C. difficile toxin enzyme immunoassay (EIA). Recurrent CDI was defined as a patient with return of diarrhea and positive stool EIA after a period of symptom resolution within 8 weeks of the first episode. Cases were patients with recurrent CDI. Controls were patients with only one episode of CDI. Variables collected at the time of first episode of CDI included demographics, laboratory findings, co-morbidities, and death within 30 days of CDI. Univariate analysis was performed using Fisher’s exact test for categorical values and Wilcoxon’s for continuous variables. Logistic regression was used to identify independent predictors of recurrent CDI.

Results: The cohort comprised 368 older adults with CDI, 80% were African American and 61% were women. Forty-nine cases with recurrent CDI were compared to 319 controls. Mean age for the cases and controls were similar (76.5±12.9 vs. 76±9.5 yr, respectively). By the McCabe score cases were more likely to have a rapidly fatal condition at admission as compared to controls (18.4% vs 14.3%; p=0.5). More of the control patients as compared to cases had a Charlson’s comorbidity index ≥3(68% vs 45% respectively (p=0.002)). Prior residency in a nursing home or rehabilitation center was noted more often in cases, 55% vs 44% (p=0.17). Similarly, hospitalization within the past 30 days was more common among cases, 69% vs 55% of controls (p=0.07). Mortality due to CDI was slightly higher in cases as compared to controls (12.2% vs 10.65%; p=0.8). On multivariate analysis cases were more likely to have low albumin (<2.5mg/dl) as compared to controls, 54% vs 36% (OR=1.98, CI 1.08-3.63; p=0.03).

Conclusions: In our predominately African American cohort of older patients with CDI, in addition to host factors such as low albumin, prior exposure to a healthcare environment was a predictor of subsequent recurrence of CDI. These older patients at risk for recurrence may be candidates for novel strategies such as C. difficile vaccine or C. difficile toxin antibody therapy.