Treatment compliance with European guidelines and prognosis of Clostridium difficile infection according to age

Age>65 years is associated with the recurrence and poor prognosis of Clostridium difficile infection (CDI). Data on elderly patients (≥75 years) is scarce, and little is known about compliance with European guidelines in terms of specific treatment. We aimed to analyze the treatment and prognosis of CDI in two groups of patients aged

We performed a prospective survey from May 2014 to April 2015 in a university hospital including all patients presenting with microbiologically confirmed CDI. Sociodemographic and clinical data, treatment of CDI, recurrences (<8 weeks after CDI treatment completion), new episodes, and mortality were recorded. Follow-up was performed until February 2016.

Overall, 101 patients were included; 45 were aged≥75 years (44.6%). More than two-thirds of CDIs (71/101) were severe. Seven per cent of patients presenting with severe CDI and 10% of patients at increased risk of recurrence received the adequate treatment as per European guidelines. Mean follow-up was 15±4 months (range: 10-22). Among patients aged≥75 years, we observed the same number of recurrences and new episodes of CDI during the follow-up. The 3-month case fatality was significantly higher in the elderly group (P<0.001). The one-year survival rate was 73.2% in younger patients and 45.7% in elderly patients (P=0.0004).

This study confirms the poor prognosis of CDI in elderly patients and highlights the lack of compliance with treatment guidelines.