Co-morbidity, not age predicts adverse outcome in clostridium difficile colitis

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 weeks (P = 0.007), low serum total protein (P = 0.034), low serum albumin (P = 0.001), antibiotic use >4 weeks (P < 0.010), 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).