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Postantibiotic colonization with Clostridium difficile in nursing home patients
D R Thomas1, R G Bennett, B E Laughon
1Divisions of Geriatric Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Journal of the American Geriatrics Society
|April 1, 1990
Summary
Clostridium difficile infection in nursing home patients after antibiotic treatment is linked to higher mortality rates. This infection acts as a significant marker of death, distinct from antibiotic risks alone.
Area of Science:
- Infectious Diseases
- Geriatrics
- Epidemiology
Background:
- Clostridium difficile causes pseudomembranous colitis and postantibiotic diarrhea.
- Previous studies noted high mortality in nursing home patients with C. difficile infection, but the cause (infection vs. antibiotics) was unclear.
Purpose of the Study:
- To determine the rate of C. difficile colonization after antibiotic treatment in a long-term care facility.
- To identify risk factors for C. difficile infection in this population.
- To ascertain if C. difficile infection is associated with increased mortality.
Main Methods:
- Prospective study over six months in a 233-bed long-term care facility.
- Collected stool specimens from 108 patients receiving 150 antibiotic courses.
- Analyzed infection rates, risk factors, and 12-month mortality.
Main Results:
- 33% of patients studied were infected with C. difficile post-antibiotic treatment.
- Ward location and stool incontinence were significant risk factors for infection.
- 12-month mortality was significantly higher in infected patients (83%) compared to non-infected (50%).
Conclusions:
- Postantibiotic Clostridium difficile infection is a marker for increased mortality in nursing home residents.
- This elevated death rate is distinguishable from risks associated with antibiotic therapy alone.
- Potential mechanisms include unrecognized colitis, toxin absorption, or endotoxin translocation.