Predictors of Clostridium difficile infection–related mortality among older adults

Teena Chopra, Reda A. Awali, Caitlin Biedron, Eileen Vallin, Suchitha Bheemreddy, Christopher M. Saddler, Keith Mullins, Jose F. Echaiz, Luigino Bernabela, Richard Severson, Dror Marchaim, Paul Lephart, Laura Johnson, Rama Thyagarajan, Keith S. Kaye, George Alangaden

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background Over 90% of annual deaths caused by Clostridium difficile infection (CDI) occur in persons aged ≥65 years. However, no large-scale studies have been conducted to investigate predictors of CDI-related mortality among older adults. Methods This case-control study included 540 CDI patients aged ≥60 years admitted to a tertiary care hospital in Detroit, Michigan, between January 2005 and December 2012. Cases were CDI patients who died within 30 days of CDI date. Controls were CDI patients who survived >30 days after CDI date. Cases were matched to controls on a 1:3 ratio based on age and hospital acquisition of CDI. Results One-hundred and thirty cases (25%) were compared with 405 controls (75%). Independent predictors of CDI-related mortality included admission from another acute hospital (odds ratio [OR], 8.25; P = .001) or a long-term care facility (OR, 13.12; P = .012), McCabe score ≥2 (OR, 12.19; P < .001), and high serum creatinine (≥1.7 mg/dL) (OR, 3.43; P = .021). The regression model was adjusted for the confounding effect of limited activity of daily living score, total number of antibiotic days prior to CDI, ileus on abdominal radiograph, low albumin (≤2.5 g/dL), elevated white blood cell count (>15 × 1,000/mm3), and admission to intensive care unit because of CDI. Conclusions Predictors of CDI-related mortality reported in this study could be applied to the development of a bedside scoring system for older adults with CDI.

Original languageEnglish (US)
Pages (from-to)1219-1223
Number of pages5
JournalAmerican Journal of Infection Control
Volume44
Issue number11
DOIs
StatePublished - Nov 1 2016
Externally publishedYes

Fingerprint

Clostridium Infections
Clostridium difficile
Mortality
Odds Ratio
Long-Term Care
Tertiary Healthcare
Tertiary Care Centers
Intensive Care Units
Case-Control Studies

Keywords

  • Clostridium difficile
  • mortality
  • older adults

ASJC Scopus subject areas

  • Epidemiology
  • Health Policy
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

Chopra, T., Awali, R. A., Biedron, C., Vallin, E., Bheemreddy, S., Saddler, C. M., ... Alangaden, G. (2016). Predictors of Clostridium difficile infection–related mortality among older adults. American Journal of Infection Control, 44(11), 1219-1223. https://doi.org/10.1016/j.ajic.2016.04.231

Predictors of Clostridium difficile infection–related mortality among older adults. / Chopra, Teena; Awali, Reda A.; Biedron, Caitlin; Vallin, Eileen; Bheemreddy, Suchitha; Saddler, Christopher M.; Mullins, Keith; Echaiz, Jose F.; Bernabela, Luigino; Severson, Richard; Marchaim, Dror; Lephart, Paul; Johnson, Laura; Thyagarajan, Rama; Kaye, Keith S.; Alangaden, George.

In: American Journal of Infection Control, Vol. 44, No. 11, 01.11.2016, p. 1219-1223.

Research output: Contribution to journalArticle

Chopra, T, Awali, RA, Biedron, C, Vallin, E, Bheemreddy, S, Saddler, CM, Mullins, K, Echaiz, JF, Bernabela, L, Severson, R, Marchaim, D, Lephart, P, Johnson, L, Thyagarajan, R, Kaye, KS & Alangaden, G 2016, 'Predictors of Clostridium difficile infection–related mortality among older adults', American Journal of Infection Control, vol. 44, no. 11, pp. 1219-1223. https://doi.org/10.1016/j.ajic.2016.04.231
Chopra, Teena ; Awali, Reda A. ; Biedron, Caitlin ; Vallin, Eileen ; Bheemreddy, Suchitha ; Saddler, Christopher M. ; Mullins, Keith ; Echaiz, Jose F. ; Bernabela, Luigino ; Severson, Richard ; Marchaim, Dror ; Lephart, Paul ; Johnson, Laura ; Thyagarajan, Rama ; Kaye, Keith S. ; Alangaden, George. / Predictors of Clostridium difficile infection–related mortality among older adults. In: American Journal of Infection Control. 2016 ; Vol. 44, No. 11. pp. 1219-1223.
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abstract = "Background Over 90{\%} of annual deaths caused by Clostridium difficile infection (CDI) occur in persons aged ≥65 years. However, no large-scale studies have been conducted to investigate predictors of CDI-related mortality among older adults. Methods This case-control study included 540 CDI patients aged ≥60 years admitted to a tertiary care hospital in Detroit, Michigan, between January 2005 and December 2012. Cases were CDI patients who died within 30 days of CDI date. Controls were CDI patients who survived >30 days after CDI date. Cases were matched to controls on a 1:3 ratio based on age and hospital acquisition of CDI. Results One-hundred and thirty cases (25{\%}) were compared with 405 controls (75{\%}). Independent predictors of CDI-related mortality included admission from another acute hospital (odds ratio [OR], 8.25; P = .001) or a long-term care facility (OR, 13.12; P = .012), McCabe score ≥2 (OR, 12.19; P < .001), and high serum creatinine (≥1.7 mg/dL) (OR, 3.43; P = .021). The regression model was adjusted for the confounding effect of limited activity of daily living score, total number of antibiotic days prior to CDI, ileus on abdominal radiograph, low albumin (≤2.5 g/dL), elevated white blood cell count (>15 × 1,000/mm3), and admission to intensive care unit because of CDI. Conclusions Predictors of CDI-related mortality reported in this study could be applied to the development of a bedside scoring system for older adults with CDI.",
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AU - Bheemreddy, Suchitha

AU - Saddler, Christopher M.

AU - Mullins, Keith

AU - Echaiz, Jose F.

AU - Bernabela, Luigino

AU - Severson, Richard

AU - Marchaim, Dror

AU - Lephart, Paul

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AU - Thyagarajan, Rama

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N2 - Background Over 90% of annual deaths caused by Clostridium difficile infection (CDI) occur in persons aged ≥65 years. However, no large-scale studies have been conducted to investigate predictors of CDI-related mortality among older adults. Methods This case-control study included 540 CDI patients aged ≥60 years admitted to a tertiary care hospital in Detroit, Michigan, between January 2005 and December 2012. Cases were CDI patients who died within 30 days of CDI date. Controls were CDI patients who survived >30 days after CDI date. Cases were matched to controls on a 1:3 ratio based on age and hospital acquisition of CDI. Results One-hundred and thirty cases (25%) were compared with 405 controls (75%). Independent predictors of CDI-related mortality included admission from another acute hospital (odds ratio [OR], 8.25; P = .001) or a long-term care facility (OR, 13.12; P = .012), McCabe score ≥2 (OR, 12.19; P < .001), and high serum creatinine (≥1.7 mg/dL) (OR, 3.43; P = .021). The regression model was adjusted for the confounding effect of limited activity of daily living score, total number of antibiotic days prior to CDI, ileus on abdominal radiograph, low albumin (≤2.5 g/dL), elevated white blood cell count (>15 × 1,000/mm3), and admission to intensive care unit because of CDI. Conclusions Predictors of CDI-related mortality reported in this study could be applied to the development of a bedside scoring system for older adults with CDI.

AB - Background Over 90% of annual deaths caused by Clostridium difficile infection (CDI) occur in persons aged ≥65 years. However, no large-scale studies have been conducted to investigate predictors of CDI-related mortality among older adults. Methods This case-control study included 540 CDI patients aged ≥60 years admitted to a tertiary care hospital in Detroit, Michigan, between January 2005 and December 2012. Cases were CDI patients who died within 30 days of CDI date. Controls were CDI patients who survived >30 days after CDI date. Cases were matched to controls on a 1:3 ratio based on age and hospital acquisition of CDI. Results One-hundred and thirty cases (25%) were compared with 405 controls (75%). Independent predictors of CDI-related mortality included admission from another acute hospital (odds ratio [OR], 8.25; P = .001) or a long-term care facility (OR, 13.12; P = .012), McCabe score ≥2 (OR, 12.19; P < .001), and high serum creatinine (≥1.7 mg/dL) (OR, 3.43; P = .021). The regression model was adjusted for the confounding effect of limited activity of daily living score, total number of antibiotic days prior to CDI, ileus on abdominal radiograph, low albumin (≤2.5 g/dL), elevated white blood cell count (>15 × 1,000/mm3), and admission to intensive care unit because of CDI. Conclusions Predictors of CDI-related mortality reported in this study could be applied to the development of a bedside scoring system for older adults with CDI.

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