Published online Apr 15, 2000. doi: 10.3748/wjg.v6.i2.198
Revised: March 6, 2000
Accepted: March 8, 2000
Published online: April 15, 2000
AIM: To examine whether age alone or co-morbidity is a risk factor for death in older adults who developed Clostridium difficile (Cd) colitis during hospitalization.
METHODS: A retrospective, observational study design was performed in our Lady of Mercy Medical Center, a 650-bed, urban, community-based, university-affiliated teaching hospital. 121 patients with a positive diagnosis of Cd colitis (aged 23-97 years) were studied, and data pertinent to demographic variables, medical history, co-morbidity, physical examination, and laboratory results were collected. Age was examined as a continuous variable and stratified into Age1 (< 80 vs 80+); Age2 (< 60, 60-69, 70-79 and 80+); or Age3 (< 60, 60-69, 70-79, 80-89, 90+).
RESULTS: Cd colitis occurs more frequently with advancing age (55% of cases > 80 years). However, age, per se, had no effect on mortality. A history of cardiac disease (P = 0.036), recurrent or refractory infection > 4 wk (P = 0.007), low serum total protein (P = 0.034), low serum albumin (P = 0.001), antibiotic use > 4 wk (P < 0.01 0), use of over 4 antibiotics (P = 0.026), and use of certain classes of antibiotics (P = 0.035-0.004) were predictive of death. Death was strongly predicted by the use of penicillin-like antibiotics plus clindamycin, in the presence of hypoalbuminemia, refractory sepsis, and cardiac disease (P = 0.00005).
CONCLUSION: Cd colitis is common in the very old. However, unlike co-morbidity, age alone does not affect the clinical outcome (survival vs death).