[Clostridium difficile diarrhea in the very old. Clinical features and course in 21 cases]

Determine the clinical and etiological features of Clostridium difficile diarrhea in elderly subjects.

We retrospectively analyzed 21 cases of C. difficile diarrhea observed in patients at the Dijon geriatric center from January 1994 through December 1995. The diagnosis was established on C. difficile toxin evidenced in fecal matter.

There were 13 women and 8 men (mean age 85.9 years). All patients had several underlying disease conditions and were highly dependent. Three outbreaks involving 11 patients were observed. In more than half of the patients, the primary clinical signs were colitis with fever, highly elevated erythrocyte sedimentation rate and high white cell count. Eleven patients also had candidiasis of the digestive tract. All patients had received one or several antibiotics during the 15 days prior to diarrhea. The main antibiotic families were aminopenicillins, cephalosporins and fluoroquinolones. Twenty patients were given specific treatment: imidazoles in 15 cases and vancomycin in 9. Diarrhea was successfully controlled in 14 cases. There were 2 cases of recurrence and 6 patients died after a cascade of complications. C. difficile infection persisted in 2 at death.

Over recent years C. difficile diarrhea has become a serious problem in geriatric units. Antibiotic therapy is the main risk factor as well as protein-calorie malnutrition, immunodeficiency, and colonic stasis. Morbidity and mortality are high in fragile elderly subjects.