Multimorbidity in elderly hospitalised patients and risk of Clostridium difficile infection: a retrospective study with the Cumulative Illness Rating Scale (CIRS).
OBJECTIVE
To identify the role of chronic comorbidities, considered together in a literature-validated index (Cumulative Illness Rating Scale, CIRS), and antibiotic or proton-pump inhibitor (PPI) treatments as risk factors for hospital-acquired Clostridium difficile infection (CDI) in elderly multimorbid hospitalised patients.


METHODS
Retrospective cohort study.


METHODS
Subacute hospital geriatric care ward in Italy.


METHODS
505 (238 male (M), 268 female (F)) elderly (age≥65) multimorbid patients.


METHODS
The relationship between CDI and CIRS Comorbidity Score, number of comorbidities, antibiotic, antifungal and PPI treatments, and length of hospital stay was assessed through age-adjusted and sex-adjusted and multivariate logistic regression models. The CIRS Comorbidity Score was handled after categorisation in quartiles.


RESULTS
Mean age was 80.7±11.3 years. 43 patients (22 M, 21 F) developed CDI. The prevalence of CDI increased among quartiles of CIRS Comorbidity Score (3.9% first quartile vs 11.1% fourth quartile, age-adjusted and sex-adjusted p=0.03). In the multivariate logistic regression analysis, patients in the highest quartile of CIRS Comorbidity Score (≥17) carried a significantly higher risk of CDI (OR 5.07, 95% CI 1.28 to 20.14, p=0.02) than patients in the lowest quartile (<9). The only other variable significantly associated with CDI was antibiotic therapy (OR 2.62, 95% CI 1.21 to 5.66, p=0.01). PPI treatment was not associated with CDI.


CONCLUSIONS
Multimorbidity, measured through CIRS Comorbidity Score, is independently associated with the risk of CDI in a population of elderly patients with prolonged hospital stay.
Internal Medicine and Critical Subacute Care Unit, Parma University Hospital, Parma, Italy Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
Andrea
A
Ticinesi
Internal Medicine and Critical Subacute Care Unit, Parma University Hospital, Parma, Italy Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
Antonio
A
Nouvenne
INAIL - CERT Research Center at University of Parma, Parma, Italy.
Giuseppina
G
Folesani
Internal Medicine and Critical Subacute Care Unit, Parma University Hospital, Parma, Italy Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
Beatrice
B
Prati
Internal Medicine and Critical Subacute Care Unit, Parma University Hospital, Parma, Italy.
Ilaria
I
Morelli
Internal Medicine and Critical Subacute Care Unit, Parma University Hospital, Parma, Italy.
Loredana
L
Guida
Laboratory of Probiogenomics, Department of Life Sciences, University of Parma, Parma, Italy.
Francesca
F
Turroni
Laboratory of Probiogenomics, Department of Life Sciences, University of Parma, Parma, Italy.
Marco
M
Ventura
Geriatrics Unit, Parma University Hospital, Parma, Italy.
Fulvio
F
Lauretani
Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
Marcello
M
Maggio
Internal Medicine and Critical Subacute Care Unit, Parma University Hospital, Parma, Italy Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
Tiziana
T
Meschi
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003015:Clostridium Infections / Q000188:drug therapy* / Q000453:epidemiology*; D015897:Comorbidity; D003428:Cross Infection / Q000188:drug therapy* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007558:Italy; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors
Antibiotic; Clostridium difficile; Elderly; Multimorbidity; Proton pump inhibitors