Is advanced age still a risk factor for recurrence of C. difficile infection in the era of new treatments?

Autor: Suárez-Carantoña C; Internal Medicine Department, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain.; Faculty of Medicine and Health Sciences, Alcalá University, Madrid, Spain., Corbacho-Loarte MD; Infectious Diseases Department, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain.; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain., Del Campo Albendea L; Biostatistics Department, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain.; CIBER de Epidemiologia y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain., Kamel-Rey S; Internal Medicine Department, Hospital Universitario Severo Ochoa, Madrid, Spain., Halperin AV; Microbiology Department, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain., Escudero-Sánchez R; Infectious Diseases Department, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain.; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain., Ponce-Alonso M; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.; Microbiology Department, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain., Moreno S; Faculty of Medicine and Health Sciences, Alcalá University, Madrid, Spain.; Infectious Diseases Department, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain.; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain., Cobo J; Infectious Diseases Department, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain.; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.
Jazyk: angličtina
Zdroj: Age and ageing [Age Ageing] 2024 Aug 06; Vol. 53 (8).
DOI: 10.1093/ageing/afae182
Abstrakt: Background: Advanced age has been widely identified as a risk factor for recurrent Clostridioides difficile infection (CDI), but most related studies were performed before the introduction of novel therapies. The aim of this study was to compare CDI characteristics and outcomes in patients over and under 80 years old with CDI and their outcomes in the era of new treatments.
Methods: This was a retrospective cohort study of patients diagnosed with CDI from January 2021 to December 2022 in an academic hospital. We compared recurrence and mortality at 12 weeks after the end of treatment. An extension of the Fine and Grey model adjusted for competing events was used to assess the effect of age on recurrence.
Results: Four hundred seventy-six patients were considered to have CDI (320 in patients <80 years and 156 in ≥80 years). CDI in older patients was more frequently healthcare-associated and was more severe. Although the Charlson index was almost identical between populations, comorbidities clearly differed. New treatments (bezlotoxumab, fidaxomicin and faecal microbiota transplantation) were more frequently used in older patients without statistical significance (41.3% vs. 33.4%, P = .053). There were 69 (14.5%) recurrences, with no differences by age group after adjusting for competing events. Mortality was greater in the oldest (35.3%) than in the youngest (13.1%); P < .001.
Conclusions: No differences in CDI recurrence rates were found between age groups. However, there was a high mortality rate in patients ≥80 years old, which emphasises the urgent need to improve the prevention and treatment of CDI in this group.
(© The Author(s) 2024. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
Databáze: MEDLINE