Age and Ageing, Vol 28, 107-113, Copyright © 1999 by British Geriatrics Society
L Kyne, C Merry, B O'Connell, A Kelly, C Keane and D O'Neill
OBJECTIVE: toxigenic Clostridium difficile is responsible for a spectrum of
disease severity ranging from mild diarrhoea to fulminant colitis. This
study attempts to determine the proportion of patients in each category of
severity and evaluate the risk factors for a more prolonged and complicated
course. DESIGN: prospective cohort study. SETTING: university teaching
hospital. SUBJECTS: all patients with symptomatic C. difficile infection
during 4 months of an outbreak (January-April 1995); n=73; median age 74
years (range 17-91). MEASUREMENTS: incidence of C. difficile-associated
disease (CDAD); severity of disease; percentage of patients in each
category of severity; risk factors for severe disease/prolonged symptoms
(univariate and multivariable analyses). RESULTS: the incidence of CDAD was
0.93%. Of the cases identified, 18 (24.7%) had mild, self-limiting disease;
26 (35.6%) had moderately severe disease; 23 (31.5%) had prolonged symptoms
and six (8.2%) had a complicated course. Although CDAD was more common in
older patients (P < 0.001), increasing age was not a risk factor for
severity. Significant risk factors for severe CDAD included low Barthel and
abbreviated mental test scores (P < 0.01, P < 0.001 respectively) and
recent endoscopy (P=0.03). Logistic regression analysis revealed the
following independent predictors of severe CDAD: endoscopy [odds ratios
(OR) 4.0, P=0.03] and cognitive impairment (OR 11.0, P < 0.01). A trend
towards significance was noted for nasogastric tube insertion (OR 3.1,
P=0.08). Complications of infection included dehydration, malnutrition and
faecal incontinence (which was statistically significantly associated with
more severe disease; P < 0.01). CONCLUSION: risk factors for severity of
CDAD include functional disability, cognitive impairment, and recent
endoscopy. Anticipation of severe CDAD may limit morbidity and mortality.
ARTICLES
Factors associated with prolonged symptoms and severe disease due to Clostridium difficile
Beth Israel Deaconess Medical Center, Gerontology Division, Boston, MA 02115, USA. lkyne@bidmc.harvard.edu
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  M. H. Wilcox, L. Mooney, R. Bendall, C. D. Settle, and W. N. Fawley A case-control study of community-associated Clostridium difficile infection J. Antimicrob. Chemother., August 1, 2008; 62(2): 388 - 396. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. D'Agata and S. L. Mitchell Patterns of Antimicrobial Use Among Nursing Home Residents With Advanced Dementia Arch Intern Med, February 25, 2008; 168(4): 357 - 362. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. J. Asha, D. Tompkins, and M. H. Wilcox Comparative Analysis of Prevalence, Risk Factors, and Molecular Epidemiology of Antibiotic-Associated Diarrhea Due to Clostridium difficile, Clostridium perfringens, and Staphylococcus aureus. J. Clin. Microbiol., August 1, 2006; 44(8): 2785 - 2791. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. G. Loo, L. Poirier, M. A. Miller, M. Oughton, M. D. Libman, S. Michaud, A.-M. Bourgault, T. Nguyen, C. Frenette, M. Kelly, et al. A Predominantly Clonal Multi-Institutional Outbreak of Clostridium difficile-Associated Diarrhea with High Morbidity and Mortality N. Engl. J. Med., December 8, 2005; 353(23): 2442 - 2449. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. J. Asha, W. N. Fawley, J. Freeman, and M. H. Wilcox Increased Rate of DNA Recovery from United Kingdom Epidemic Clostridium difficile PCR Ribotype 1 Strains Stored Cryogenically J. Clin. Microbiol., November 1, 2005; 43(11): 5794 - 5795. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. V McFarland Alternative treatments for Clostridium difficile disease: what really works? J. Med. Microbiol., February 1, 2005; 54(2): 101 - 111. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Kyne, M. Warny, A. Qamar, and C. P. Kelly Asymptomatic Carriage of Clostridium difficile and Serum Levels of IgG Antibody against Toxin A N. Engl. J. Med., February 10, 2000; 342(6): 390 - 397. [Abstract] [Full Text] [PDF]
|
|