Original Articles
Copyright ©The Author(s) 2000. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 15, 2000; 6(2): 198-201
Published online Apr 15, 2000. doi: 10.3748/wjg.v6.i2.198
Co-morbidity, not age predicts adverse outcome in Clostridium difficile colitis
TS Dharmarajan, M Sipalay, R Shyamsundar, EP Norkus, CS Pitchumoni
TS Dharmarajan, M Sipalay, Divisions of Geriatrics, Our Lady of Mercy Medical Center, Bronx, New York, USA;
CS Pitchumoni, Gastroenterology, Our Lady of Mercy Medical Center, Bronx, New York, USA;
R Shyamsundar, EP Norkus, Department of Biomedical Research, Our Lady of Mercy Medical Center, Bronx, New York, USA;
TS Dharmarajan, is responsible for developing a Division of Geriatrics (92 beds) in the above University Teaching Hospital. The Geriatrics program, initiated in 1991, has components of in-patient, out-patient, and long-term care.
TS Dharmarajan, also developed a Geriatric Medicine Fellowship program at the same institution. The Fellowship program, one of the largest in the USA, is accredited for eight fellows and offers training in Geriatrics at all levels (medical students, interns, residents, fellows).
Author contributions: All authors contributed equally to the work.
Correspondence to: T.S. Dharmarajan, MD, Division of Geriatrics, Our Lady of Mercy Medical Center, 4141 Carpenter Avenue, Bronx, NY 10466.
Telephone: (718)920-9041, Fax. (914)723-4297
Received: February 12, 2000
Revised: March 6, 2000
Accepted: March 8, 2000
Published online: April 15, 2000
Abstract

AIM: To examine whether age alone or co-morbidity is a risk factor for death in older adults who developed Clostridium difficile (Cd) colitis during hospitalization.

METHODS: A retrospective, observational study design was performed in our Lady of Mercy Medical Center, a 650-bed, urban, community-based, university-affiliated teaching hospital. 121 patients with a positive diagnosis of Cd colitis (aged 23-97 years) were studied, and data pertinent to demographic variables, medical history, co-morbidity, physical examination, and laboratory results were collected. Age was examined as a continuous variable and stratified into Age1 (＜ 80 vs 80+); Age2 (＜ 60, 60-69, 70-79 and 80+); or Age3 (＜ 60, 60-69, 70-79, 80-89, 90+).

RESULTS: Cd colitis occurs more frequently with advancing age (55% of cases ＞ 80 years). However, age, per se, had no effect on mortality. A history of cardiac disease (P = 0.036), recurrent or refractory infection ＞ 4 wk (P = 0.007), low serum total protein (P = 0.034), low serum albumin (P = 0.001), antibiotic use ＞ 4 wk (P ＜ 0.01 0), use of over 4 antibiotics (P = 0.026), and use of certain classes of antibiotics (P = 0.035-0.004) were predictive of death. Death was strongly predicted by the use of penicillin-like antibiotics plus clindamycin, in the presence of hypoalbuminemia, refractory sepsis, and cardiac disease (P = 0.00005).

CONCLUSION: Cd colitis is common in the very old. However, unlike co-morbidity, age alone does not affect the clinical outcome (survival vs death).

Keywords: Clostridium difficile, colitis/old age, comorbidity/old age, diarrhea, colitis/therapy, physical examination