Does accepted definition of Clostridioides difficile infection (CDI) severity predict poor outcomes in older adults?
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...
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| Veröffentlicht in: | Aging clinical and experimental research 2022-03, Vol.34 (3), p.583-589 |
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| creator | Atamna, Alaa Babich, Tanya Margalit, Ili Avni, Tomer Ben Zvi, Haim Raz, Noa-Eliakim Yahav, Dafna Bishara, Jihad |
| description | 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 ( |
| doi_str_mv | 10.1007/s40520-021-01953-5 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2564135551</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2564135551</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-ab72dfd32c1a869fb0142719c27444fbab6896137969af657fedf51165a03d1d3</originalsourceid><addsrcrecordid>eNp9kUtLHTEYhoNU6q1_oIsS6EYXo7nPzKqUY73AATe6DpnkS4nMmUyTTMF_3xyPttKFq9ye903Ig9BnSs4pIe1FFkQy0hBGG0J7yRu5hw5pW7c6TvsPb-YH6CjnR0IErYuP6IALwVQvxCEqlxEyNtbCXMBhBz5MoYQ44ejxaoy5pOBCDK5SLngfbBgBh8mDfaZOV5e3ZzjDb0ihPOE5gQu24DnGhONSbNzUYKhto4OEjVvGkr-doH1vxgyfXsZj9HD1435106zvrm9X39eN5a0sjRla5rzjzFLTqd4PhArW0t6yVgjhBzOorleUt73qjVey9eC8pFRJQ7ijjh-j013vnOKvBXLRm5AtjKOZIC5ZM6nqj0gpaUW__oc-xiVN9XWaKS4571S3pdiOsinmnMDrOYWNSU-aEr11ondOdHWin51oWUNfXqqXYQPub-RVQgX4Dsj1aPoJ6d_d79T-Abc5lyQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2635338681</pqid></control><display><type>article</type><title>Does accepted definition of Clostridioides difficile infection (CDI) severity predict poor outcomes in older adults?</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Atamna, Alaa ; Babich, Tanya ; Margalit, Ili ; Avni, Tomer ; Ben Zvi, Haim ; Raz, Noa-Eliakim ; Yahav, Dafna ; Bishara, Jihad</creator><creatorcontrib>Atamna, Alaa ; Babich, Tanya ; Margalit, Ili ; Avni, Tomer ; Ben Zvi, Haim ; Raz, Noa-Eliakim ; Yahav, Dafna ; Bishara, Jihad</creatorcontrib><description>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.</description><identifier>ISSN: 1720-8319</identifier><identifier>ISSN: 1594-0667</identifier><identifier>EISSN: 1720-8319</identifier><identifier>DOI: 10.1007/s40520-021-01953-5</identifier><identifier>PMID: 34426944</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Age ; Aged ; Aging ; Antibiotics ; Antigens ; Clostridioides difficile ; Clostridium Infections - diagnosis ; Clostridium Infections - epidemiology ; Colorectal surgery ; Comorbidity ; Creatinine ; Dementia ; Geriatrics/Gerontology ; Hospitalization ; Hospitals ; Humans ; Infections ; Infectious diseases ; Intensive care ; Internal medicine ; Laboratories ; Medicine ; Medicine & Public Health ; Mortality ; Odds Ratio ; Older people ; Original Article ; Patients ; Population ; Retrospective Studies ; Risk Factors ; Variables</subject><ispartof>Aging clinical and experimental research, 2022-03, Vol.34 (3), p.583-589</ispartof><rights>The Author(s), under exclusive licence to Springer Nature Switzerland AG 2021</rights><rights>2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.</rights><rights>The Author(s), under exclusive licence to Springer Nature Switzerland AG 2021.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-ab72dfd32c1a869fb0142719c27444fbab6896137969af657fedf51165a03d1d3</citedby><cites>FETCH-LOGICAL-c375t-ab72dfd32c1a869fb0142719c27444fbab6896137969af657fedf51165a03d1d3</cites><orcidid>0000-0002-1351-7135</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s40520-021-01953-5$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s40520-021-01953-5$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34426944$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Atamna, Alaa</creatorcontrib><creatorcontrib>Babich, Tanya</creatorcontrib><creatorcontrib>Margalit, Ili</creatorcontrib><creatorcontrib>Avni, Tomer</creatorcontrib><creatorcontrib>Ben Zvi, Haim</creatorcontrib><creatorcontrib>Raz, Noa-Eliakim</creatorcontrib><creatorcontrib>Yahav, Dafna</creatorcontrib><creatorcontrib>Bishara, Jihad</creatorcontrib><title>Does accepted definition of Clostridioides difficile infection (CDI) severity predict poor outcomes in older adults?</title><title>Aging clinical and experimental research</title><addtitle>Aging Clin Exp Res</addtitle><addtitle>Aging Clin Exp Res</addtitle><description>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.</description><subject>Age</subject><subject>Aged</subject><subject>Aging</subject><subject>Antibiotics</subject><subject>Antigens</subject><subject>Clostridioides difficile</subject><subject>Clostridium Infections - diagnosis</subject><subject>Clostridium Infections - epidemiology</subject><subject>Colorectal surgery</subject><subject>Comorbidity</subject><subject>Creatinine</subject><subject>Dementia</subject><subject>Geriatrics/Gerontology</subject><subject>Hospitalization</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Infections</subject><subject>Infectious diseases</subject><subject>Intensive care</subject><subject>Internal medicine</subject><subject>Laboratories</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mortality</subject><subject>Odds Ratio</subject><subject>Older people</subject><subject>Original Article</subject><subject>Patients</subject><subject>Population</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Variables</subject><issn>1720-8319</issn><issn>1594-0667</issn><issn>1720-8319</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kUtLHTEYhoNU6q1_oIsS6EYXo7nPzKqUY73AATe6DpnkS4nMmUyTTMF_3xyPttKFq9ye903Ig9BnSs4pIe1FFkQy0hBGG0J7yRu5hw5pW7c6TvsPb-YH6CjnR0IErYuP6IALwVQvxCEqlxEyNtbCXMBhBz5MoYQ44ejxaoy5pOBCDK5SLngfbBgBh8mDfaZOV5e3ZzjDb0ihPOE5gQu24DnGhONSbNzUYKhto4OEjVvGkr-doH1vxgyfXsZj9HD1435106zvrm9X39eN5a0sjRla5rzjzFLTqd4PhArW0t6yVgjhBzOorleUt73qjVey9eC8pFRJQ7ijjh-j013vnOKvBXLRm5AtjKOZIC5ZM6nqj0gpaUW__oc-xiVN9XWaKS4571S3pdiOsinmnMDrOYWNSU-aEr11ondOdHWin51oWUNfXqqXYQPub-RVQgX4Dsj1aPoJ6d_d79T-Abc5lyQ</recordid><startdate>20220301</startdate><enddate>20220301</enddate><creator>Atamna, Alaa</creator><creator>Babich, Tanya</creator><creator>Margalit, Ili</creator><creator>Avni, Tomer</creator><creator>Ben Zvi, Haim</creator><creator>Raz, Noa-Eliakim</creator><creator>Yahav, Dafna</creator><creator>Bishara, Jihad</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-1351-7135</orcidid></search><sort><creationdate>20220301</creationdate><title>Does accepted definition of Clostridioides difficile infection (CDI) severity predict poor outcomes in older adults?</title><author>Atamna, Alaa ; Babich, Tanya ; Margalit, Ili ; Avni, Tomer ; Ben Zvi, Haim ; Raz, Noa-Eliakim ; Yahav, Dafna ; Bishara, Jihad</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-ab72dfd32c1a869fb0142719c27444fbab6896137969af657fedf51165a03d1d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Age</topic><topic>Aged</topic><topic>Aging</topic><topic>Antibiotics</topic><topic>Antigens</topic><topic>Clostridioides difficile</topic><topic>Clostridium Infections - diagnosis</topic><topic>Clostridium Infections - epidemiology</topic><topic>Colorectal surgery</topic><topic>Comorbidity</topic><topic>Creatinine</topic><topic>Dementia</topic><topic>Geriatrics/Gerontology</topic><topic>Hospitalization</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Infections</topic><topic>Infectious diseases</topic><topic>Intensive care</topic><topic>Internal medicine</topic><topic>Laboratories</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mortality</topic><topic>Odds Ratio</topic><topic>Older people</topic><topic>Original Article</topic><topic>Patients</topic><topic>Population</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Variables</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Atamna, Alaa</creatorcontrib><creatorcontrib>Babich, Tanya</creatorcontrib><creatorcontrib>Margalit, Ili</creatorcontrib><creatorcontrib>Avni, Tomer</creatorcontrib><creatorcontrib>Ben Zvi, Haim</creatorcontrib><creatorcontrib>Raz, Noa-Eliakim</creatorcontrib><creatorcontrib>Yahav, Dafna</creatorcontrib><creatorcontrib>Bishara, Jihad</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Aging clinical and experimental research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Atamna, Alaa</au><au>Babich, Tanya</au><au>Margalit, Ili</au><au>Avni, Tomer</au><au>Ben Zvi, Haim</au><au>Raz, Noa-Eliakim</au><au>Yahav, Dafna</au><au>Bishara, Jihad</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Does accepted definition of Clostridioides difficile infection (CDI) severity predict poor outcomes in older adults?</atitle><jtitle>Aging clinical and experimental research</jtitle><stitle>Aging Clin Exp Res</stitle><addtitle>Aging Clin Exp Res</addtitle><date>2022-03-01</date><risdate>2022</risdate><volume>34</volume><issue>3</issue><spage>583</spage><epage>589</epage><pages>583-589</pages><issn>1720-8319</issn><issn>1594-0667</issn><eissn>1720-8319</eissn><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.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>34426944</pmid><doi>10.1007/s40520-021-01953-5</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-1351-7135</orcidid></addata></record> |
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| identifier | ISSN: 1720-8319 |
| ispartof | Aging clinical and experimental research, 2022-03, Vol.34 (3), p.583-589 |
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| language | eng |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Age Aged Aging Antibiotics Antigens Clostridioides difficile Clostridium Infections - diagnosis Clostridium Infections - epidemiology Colorectal surgery Comorbidity Creatinine Dementia Geriatrics/Gerontology Hospitalization Hospitals Humans Infections Infectious diseases Intensive care Internal medicine Laboratories Medicine Medicine & Public Health Mortality Odds Ratio Older people Original Article Patients Population Retrospective Studies Risk Factors Variables |
| title | Does accepted definition of Clostridioides difficile infection (CDI) severity predict poor outcomes in older adults? |
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