title: Clostridium difficile Infection in Older Adults: Systematic Review of Efforts to Reduce Occurrence and Improve Outcomes.
abstract: OBJECTIVE
  Provide a systematic review of the primary literature on efforts to reduce Clostridium difficile infection (CDI) occurrence and improve outcomes in older adults.
  PubMed and CINAHL databases were searched for research studies using search terms CDI, CDI prevention, reduction, control, management, geriatric, elderly, adults 65 years of age and older. The MeSH categories Aged and Aged, 80 and older, were used. A second search of PubMed, CINAHL, National Guideline Clearinghouse, and TRIP databases was conducted for primary, secondary, and tertiary literature for CDI epidemiology, burden, and management in adults of all ages, and prevention and management guidelines. Of the 2,263 articles located, 105 were selected for full review: 55 primary and 50 secondary, tertiary. Primary literature selected for full review included studies of interventions to prevent, reduce occurrence, control, manage, or improve outcomes in adults 65 years of age and older. Patient settings included the community, assisted living, nursing facility, subacute care, or hospital.
  
  
  RESULTS
  The main outcome measures for research studies were whether the studied intervention prevented, reduced occurrence, controlled, managed, or improved outcomes. Studies were conducted in acute or long-term hospitals, with a few in nursing facilities. Interventions that prevented or reduced CDI included antibiotic policy changes, education, procedure changes, infection control, and multi-intervention approaches. There were few management studies for adults 65 years of age and older or for all adults with results stratified by age. Treatments studied included efficacy of fidaxomicin, metronidazole, vancomycin, and fecal microbiota transplant. Though clinical outcomes were slightly less robust in those 65 years of age and older, age was not an independent predictor of success or failure. The current prevention and management guidelines for adults of all ages, as well as special considerations in skilled nursing facilities, extracted from the secondary/tertiary literature selected, are summarized.
  
  
  CONCLUSIONS
  There are a limited number of studies designed for older adults. Our findings suggest that guideline recommendations for adults are adequate and appropriate for older adults. Exposure to antibiotics and Clostridium difficile remain the two major risk factors for CDI, reinforcing the importance of antibiotic stewardship and infection control.
authors.forename: Leisa L
authors.initials: LL
authors.lastname: Marshall
authors.forename: Samuel
authors.initials: S
authors.lastname: Peasah
authors.forename: Gregg A
authors.initials: GA
authors.lastname: Stevens
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016360:Clostridioides difficile; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000517:prevention & control*; D006707:Homes for the Aged / Q000458:organization & administration; D006801:Humans; D017053:Infection Control / Q000458:organization & administration*; D007318:Inservice Training; D009735:Nursing Homes / Q000458:organization & administration; D010043:Outcome and Process Assessment, Health Care; D057766:Policy; D017410:Practice Guidelines as Topic; D012008:Recurrence; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents