Clostridium difficile colitis in older adults in long-term facilities and the community: do their outcomes differ?

To determine if older adults from long-term care facilities (LTCF) have a greater risk of death than older people in the community after the development of Clostridium difficile (CD) colitis during hospitalization.

A retrospective review of medical records from all older hospitalized patients with a confirmed diagnosis of CD colitis from February 1995 to February 1997 at Our Lady of Mercy Medical Center, Bronx, NY, a University hospital of the New York Medical College.

A total of 108 patients (aged 60-97 yrs.) with a positive diagnosis of CD colitis (EIA of CD cytotoxin A and B) were identified. Residence (nursing home vs. community), sex and age, length of hospital stay, laboratory values, the number, dose, and duration of all antibiotics used, and co-morbid medical conditions were examined as potential risk factors for adverse outcome (mortality).

Fifty-two nursing home and 56 older patients living in the community were compared. Outcome (survival vs. death) was equivalent between nursing home (13 of 52 died, 25% death rate) and community elderly (13 of 56 died, 23% death rate). The patients in the nursing home were, on average, 3 years older than community those in the community, but age was not related to outcome in either group. Death occurred significantly more often in LTCF and community patients who received prolonged antibiotic therapy (P = 0.0056) or were prescribed four or more antibiotics (P = 0.036) during hospitalization. Low serum albumin level was found to be a strong predictor of death (P = 0.002). However, nursing home and community elderly had similar mean serum albumin levels (P = 0.2797). Death was also predicted by the use of clindamycin alone (P = 0.046) or penicillin-like antibiotics (excluding cephalosporins) and clindamycin (P = 0.021), or a history of cardiac disease (coronary artery disease or congestive heart failure) (P = 0.022).

Patients from LTCF do not have an increased risk of mortality compared with older people in the community after developing CD colitis during hospitalization. Factors such as low serum albumin, prolonged antibiotic therapy, the number of antibiotics used, use of specific antibiotics, and cardiac disease were significantly related to an increased risk of death in both LTCF and community older adults. Age did not influence outcome in either group of older adults.