Clostridium difficile-associated disease and mortality among the elderly critically ill
- 1 September 2009
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Critical Care Medicine
- Vol. 37 (9), 2583-2589
- https://doi.org/10.1097/ccm.0b013e3181ab8388
Abstract
Objective: To describe the epidemiology of and to develop a simple 30-day mortality clinical decision rule among critically ill patients ≥65 yrs. Increasing incidence of hospitalizations with and emergence of hypervirulent epidemic strains have made Clostridium difficile-associated disease an important public health concern. Advanced age is a risk factor for development of and death from Clostridium difficile-associated disease. Intensive care unit patients with Clostridium difficile-associated disease have a high mortality, but neither the burden of nor risk factors for death among the elderly intensive care unit patients with Clostridium difficile-associated disease are well understood. Design: Secondary analysis of a retrospective cohort study. Setting: All intensive care units at a single academic institution. Patients: A total of 278 critically ill patients with Clostridium difficile-associated disease; n = 148 aged ≥65 yrs. Interventions: None in addition to routine intensive care unit care. Measurements and Main Results: Univariate analyses were performed to compare characteristics and outcomes of the elderly vs. the younger groups, and elderly 30-day survivors with nonsurvivors. Multivariable logistic regression model was developed with 30-day mortality as a dependent variable. Covariates retained in the model were assigned weighted points to develop a 30-day mortality prediction score. Area under the receiver operating characteristics curve and cross-validation analyses evaluated the score characteristics. Elderly patients were 68% more likely to experience 30-day mortality than the younger group. Absence of chronic respiratory disease (R), age 75+ yrs (A), septic shock (S), and Acute Physiology and Chronic Health Evaluation II score 20+ (A) comprised the RASA score, whose receiver operating characteristics was 0.740; 95% Confidence Interval was 0.663–0.817. Conclusions: Elderly patients represent approximately 50% of intensive care unit patients with Clostridium difficile-associated disease and have a higher 30-day mortality than younger patients. A simple prediction rule incorporating determinants of 30-day mortality easily available at the bedside may aid in optimizing treatment decisions in this growing population.Keywords
This publication has 21 references indexed in Scilit:
- GROWTH IN THE INCIDENCE OF HOSPITALIZATIONS WITH RESISTANT INFECTIONS IN ELDERLY PEOPLE IN THE UNITED STATES: 2000 TO 2006Journal of the American Geriatrics Society, 2008
- Increase in AdultClostridium difficile–related Hospitalizations and Case-Fatality Rate, United States, 2000–2005Emerging Infectious Diseases, 2008
- Health Care-Associated Pneumonia and Community-Acquired Pneumonia: a Single-Center ExperienceAntimicrobial Agents and Chemotherapy, 2007
- Analysis of 30-Day Mortality for Clostridium difficile -Associated Disease in the ICU SettingChest, 2007
- Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock*Critical Care Medicine, 2006
- Clostridium difficileInfection in Patients Discharged from US Short-stay Hospitals, 1996–20031Emerging Infectious Diseases, 2006
- Clinical Importance of Delays in the Initiation of Appropriate Antibiotic Treatment for Ventilator-Associated PneumoniaChest, 2002
- The Commonality of Risk Factors for Nosocomial Colonization and Infection with Antimicrobial-Resistant Staphylococcus aureus, Enterococcus, Gram-Negative Bacilli, Clostridium difficile, and CandidaAnnals of Internal Medicine, 2002
- Inadequate Antimicrobial Treatment of InfectionsChest, 1999
- Modification of empiric antibiotic treatment in patients with pneumonia acquired in the intensive care unitIntensive Care Medicine, 1996