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Lee, Kim, Jeong, Lee, Jang, and Kim: Clinical Outcomes in Hospitalized Patients with Clostridium difficile Infection by Age Group
Original Article

Korean J Gastroenterol 2016;67(2):81-86.

Published online: 4 October 2016

DOI: https://doi.org/10.4166/kjg.2016.67.2.81

Clinical Outcomes in Hospitalized Patients with Clostridium difficile Infection by Age Group

Ho Chan Lee, Kyeong Ok Kim, Yo Han Jeong, Si Hyung Lee, Byung Ik Jang, Tae Nyeun Kim

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea

Correspondence to: Kyeong Ok Kim, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Namgu, Daegu 42415, Korea. Tel: +82-53-620-3835, Fax: +82-53-623-8038, E-mail: kokim@yu.ac.kr

Received 13 November 2015       Revised 7 January 2016       Accepted 8 January 2016

Copyright © 2016 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Advanced age is a known risk factor of poor outcomes for colitis, including Clostridium difficile infection (CDI). The present study compares the clinical outcomes of young and old patients hospitalized for CDI.

Methods

The clinical records of patients admitted from January 2007 to December 2013 with a diagnosis of CDI were analyzed. Patient baseline characteristics, clinical courses, and outcomes were compared with respect to age using a cut-off 65 years.

Results

Of the 241,391 inpatients registered during the study period, 225 (0.1%) with a diagnosis of CDI were included in the study. The mean patient age was 67.7 years. Seventy-two patients (32.0%) were younger than 65 years and 153 patients (68.0%) were 65 years old or more. The male to female ratio in the younger group was 0.8, and 0.58 in the older group. All 225 study subjects had watery diarrhea; six patients (8.3%) complained of bloody diarrhea in the young group and 21 patients (13.7%) in the old group (p=0.246). Right colon involvement was more common in the old group (23.5% vs. 42.7%, p=0.033). Furthermore, leukocytosis (41.7% vs. 67.3%, p=0.000), a CDI score of ≥3 points (77.8% vs. 89.5%, p=0.018), and hypoalbuminemia (58.3% vs. 76.5%, p=0.005) were more common in the old group. Failure to first line treatment was more common in the old group (17 [23.6%] vs. 58 [37.9%], p=0.034).

Conclusions

Severe colitis and failure to first line treatment were significantly more common in patients age 65 years or more. More aggressive initial treatment should be considered for older CDI patients.

Keywords: Clostridium difficile infection, Elderly, Severity, Treatment

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Table 1.
Patient Baseline Characteristics
Characteristic Young group (n=72) Old group (n=153) p-value
Mean age (yr) 49.5±12.3 76.3±6.5  
Gender (male:female) 32:40 (0.8:1) 54:93 (0.58:1) 0.215
Underlying diseases      
  Hypertension 19 (26.4) 82 (53.6) 0.000
  Diabetes mellitus 15 (20.8) 38 (24.8) 0.509
  Cancer 8 (11.1) 13 (8.5) 0.529
Ambulation 50 (69.4) 83 (54.2) 0.031
Duration from admission to diagnosis (day) 11.1±16.7 8.7±14.8 0.294
Antibiotics before diagnosed as CDI      
  Cephalosporins 39 (54.2) 74 (48.4)  
  Quinolones 18 (25.0) 39 (25.5)  
  Penicillins 6 (8.3) 16 (10.5)  
  Anti-tuberculous drug 5 (6.9) 6 (3.9)  
Othersa 4 (5.6) 18 (11.7)  
Duration of antibiotics exposure 7.6±5.5 7.1±5.0 0.593
H2-blocker or PPI b usage 48 (66.7) 119 (77.8) 0.076
Diagnostic modality      
  C. difficile-toxin assay 68 (94.4) 144 (94.1) 0.922
  Endoscopy 28 (38.9) 62 (40.5) 0.815

Values are presented as mean±SD, n only, or n (%).

Young group, less than 65 years; old group, 65 years and up.

CDI, Clostridium difficile infection; PPI: proton pump inhibitor.

a Carbapenem, aminoglycosides

b within 30 days before presentation.

Table 2.
Clinical Characteristics of the Two Study Groups
Characteristic Young group (n=72) Old group (n=153) p-value
Right colon involvement Symptoms 8/34 (23.5) 35/82 (42.7) 0.033
  Watery diarrhea 72 (100) 153 (100)  
  Blood in stool 6 (8.3) 21 (13.7) 0.246
  Abdominal pain 26 (36.1) 63 (41.2) 0.469
  Fever 54 (75.0) 124 (81.0) 0.298
  Hypotension 22 (30.6) 45 (29.4) 0.861
Leukocytosis 30 (41.7) 103 (67.3) 0.000
Hypokalemia 23 (32.4) 48 (31.4) 0.878
Kidney failure 18 (25.0) 40 (26.1) 0.855
Hypoalbuminemia 42 (58.3) 117 (76.5) 0.005
Severity      
1 4 (5.6) 3 (2.0)  
2 12 (16.7) 13 (8.5)  
3 54 (75.0) 134 (87.6)  
4 2 (2.8) 3 (2.0)  

Values are presented as n (%).

Young group, less than 65 years; old group, 65 years and up.

Table 3.
Clinical Outcomes in the Young and Old Study Groups
Variable Young group (n=72) Old group (n=153) p-value
Failure of 1st line treatment 17 (23.6) 58 (37.9) 0.034
Recurrence 6 (8.3) 23 (15.0) 0.162
Time to recurrence (day) 33.6±8.2 25.1±11.0 0.479
Associated mortality 1 (1.4) 9 (5.9) 0.127

Values are presented as n (%) or mean±SD.

Young group, less than 65 years; old group, 65 years and up.

Table 4.
Clinical Comparisons of Patients by Response to First Line Treatment
  Failure (n=75) Success (n=150) p-value
Age ≥65 years 58 (77.3) 95 (63.3) 0.035
Right colon involvement 19/41 24/71 0.228
Bloody diarrhea 9 (12.0) 18 (12.0) 1.000
Hypotension 21 (28.0) 46 (30.7) 0.758
Leukocytosis 52 (69.3) 81 (54.0) 0.031
Hypoalbuminemia 59 (78.7) 100 (66.7) 0.042

Values are presented as n (%) or n only.

Table 5.
Risk Factors for First Line Treatment Failure
Parameter OR 95% CI p-value
Age ≥65 years 0.157 0.300–1.105 0.097
Leukocytosis 1.716 0.939–3.316 0.079
Hypoalbuminemia 1.498 0.761–2.951 0.242
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