title: Predictors of Clostridium difficile infection-related mortality among older adults.
abstract: Over 90% of annual deaths caused by Clostridium difficile infection (CDI) occur in persons aged ≥65 years. However, no large-scale studies have been conducted to investigate predictors of CDI-related mortality among older adults.
  
  
  
  This case-control study included 540 CDI patients aged ≥60 years admitted to a tertiary care hospital in Detroit, Michigan, between January 2005 and December 2012. Cases were CDI patients who died within 30 days of CDI date. Controls were CDI patients who survived >30 days after CDI date. Cases were matched to controls on a 1:3 ratio based on age and hospital acquisition of CDI.
  
  
  
  One-hundred and thirty cases (25%) were compared with 405 controls (75%). Independent predictors of CDI-related mortality included admission from another acute hospital (odds ratio [OR], 8.25; P = .001) or a long-term care facility (OR, 13.12; P = .012), McCabe score ≥2 (OR, 12.19; P < .001), and high serum creatinine (≥1.7 mg/dL) (OR, 3.43; P = .021). The regression model was adjusted for the confounding effect of limited activity of daily living score, total number of antibiotic days prior to CDI, ileus on abdominal radiograph, low albumin (≤2.5 g/dL), elevated white blood cell count (>15 × 1,000/mm3), and admission to intensive care unit because of CDI.
  
  
  
  Predictors of CDI-related mortality reported in this study could be applied to the development of a bedside scoring system for older adults with CDI.
authors.affiliation: Division of Infectious Diseases, Detroit Medical Center & Wayne State University, Detroit, MI.
authors.forename: Teena
authors.initials: T
authors.lastname: Chopra
authors.affiliation: Division of Infectious Diseases, Detroit Medical Center & Wayne State University, Detroit, MI. Electronic address: rawali@med.wayne.edu.
authors.forename: Reda A
authors.initials: RA
authors.lastname: Awali
authors.affiliation: Division of Infectious Diseases, Detroit Medical Center & Wayne State University, Detroit, MI.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Biedron
authors.affiliation: Division of Infectious Diseases, Detroit Medical Center & Wayne State University, Detroit, MI.
authors.forename: Eileen
authors.initials: E
authors.lastname: Vallin
authors.affiliation: Division of Infectious Diseases, Detroit Medical Center & Wayne State University, Detroit, MI.
authors.forename: Suchitha
authors.initials: S
authors.lastname: Bheemreddy
authors.affiliation: Division of Infectious Diseases, Detroit Medical Center & Wayne State University, Detroit, MI.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Saddler
authors.affiliation: Division of Infectious Diseases, Detroit Medical Center & Wayne State University, Detroit, MI.
authors.forename: Keith
authors.initials: K
authors.lastname: Mullins
authors.affiliation: Henry Ford Health System, Detroit, MI.
authors.forename: Jose F
authors.initials: JF
authors.lastname: Echaiz
authors.affiliation: Division of Infectious Diseases, Detroit Medical Center & Wayne State University, Detroit, MI.
authors.forename: Luigino
authors.initials: L
authors.lastname: Bernabela
authors.affiliation: Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI.
authors.forename: Richard
authors.initials: R
authors.lastname: Severson
authors.affiliation: Division of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Dror
authors.initials: D
authors.lastname: Marchaim
authors.affiliation: Division of Infectious Diseases, Detroit Medical Center & Wayne State University, Detroit, MI.
authors.forename: Paul
authors.initials: P
authors.lastname: Lephart
authors.affiliation: Henry Ford Health System, Detroit, MI.
authors.forename: Laura
authors.initials: L
authors.lastname: Johnson
authors.affiliation: Oakwood Hospital, Dearborn, MI.
authors.forename: Rama
authors.initials: R
authors.lastname: Thyagarajan
authors.affiliation: Division of Infectious Diseases, Detroit Medical Center & Wayne State University, Detroit, MI.
authors.forename: Keith S
authors.initials: KS
authors.lastname: Kaye
authors.affiliation: Henry Ford Health System, Detroit, MI.
authors.forename: George
authors.initials: G
authors.lastname: Alangaden
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000382:microbiology / Q000401:mortality*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008824:Michigan; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D062606:Tertiary Care Centers
keywords: Clostridium difficile; mortality; older adults