Top

Published in:

01-09-2013 | Infectious Diseases in the Elderly (SF Bradley, Section Editor)

Changing Epidemiology and Control of Clostridium difficile in Older Adults

Authors: Natasha Bagdasarian, Krishna Rao, Preeti N. Malani

Published in: Current Geriatrics Reports | Issue 3/2013

Abstract

Clostridium difficile infection (CDI) presents unique clinical challenges among older adults. Older patients tend to have more severe disease, more treatment failures, and higher rates of relapse. As the burden of CDI in older adults continues to grow, better paradigms for the prevention and treatment of CDI in this vulnerable population will be essential. In this review, we offer an overview of the changing epidemiology of C. difficile, with a review of CDI prevention, diagnosis and treatment, with a focus on older patients.

Bartlett JG. Narrative review: the new epidemic of Clostridium difficile-associated enteric disease. Ann Intern Med. 2006;145(10):758–64.PubMedCrossRef

Kyne L, Hamel MB, Polavaram R, et al. Health care costs and mortality associated with nosocomial diarrhea due to Clostridium difficile. Clin Infect Dis. 2002;34(3):346–53.PubMedCrossRef

McDonald LC, Owings M, Jernigan DB. Clostridium difficile infection in patients discharged from US short-stay hospitals, 1996–2003. Emerg Infect Dis. 2006;12(3):409–15.PubMedCrossRef

Dubberke ER, Wertheimer AI. Review of current literature on the economic burden of Clostridium difficile infection. Infect Control Hosp Epidemiol. 2009;30(1):57–66.PubMedCrossRef

Akerlund T, Persson I, Unemo M, et al. Increased sporulation rate of epidemic Clostridium difficile type 027/NAP1. J Clin Microbiol. 2008;46(4):1530–3.PubMedCrossRef

McDonald LC, Killgore GE, Thompson A, et al. An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med. 2005;353(23):2433–41.PubMedCrossRef

Pepin J, Valiquette L, Alary ME, et al. Clostridium difficile-associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity. CMAJ. 2004;171(5):466–72.PubMed

Dubberke ER, Reske KA, Yan Y, et al. Clostridium difficile–associated disease in a setting of endemicity: identification of novel risk factors. Clin Infect Dis. 2007;45(12):1543–9.PubMedCrossRef

Garey KW, Dao-Tran TK, Jiang ZD, et al. A clinical risk index for Clostridium difficile infection in hospitalised patients receiving broad-spectrum antibiotics. J Hosp Infect. 2008;70(2):142–7.PubMedCrossRef

10.

Howitt JR, Grace JW, Schaefer MG, et al. Clostridium difficile-positive stools: a retrospective identification of risk factors. Am J Infect Control. 2008;36(7):488–91.PubMedCrossRef

11.

•• Henrich TJ, Krakower D, Bitton A, et al. Clinical risk factors for severe Clostridium difficile-associated disease. Emerg Infect Dis. 2009;15(3):415–22. Retrospective review identifying factors associated with severe CDI, including age >70 years.PubMedCrossRef

12.

Loo VG, Poirier L, Miller MA, et al. A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med. 2005;353(23):2442–9.PubMedCrossRef

13.

Zilberberg MD, Shorr AF, Kollef MH. Increase in adult Clostridium difficile-related hospitalizations and case-fatality rate, United States, 2000–2005. Emerg Infect Dis. 2008;14(6):929–31.PubMedCrossRef

14.

Brown E, Talbot GH, Axelrod P, et al. Risk factors for Clostridium difficile toxin-associated diarrhea. Infect Control Hosp Epidemiol. 1990;11(6):283–90.PubMedCrossRef

15.

McFarland LV, Surawicz CM, Stamm WE. Risk factors for Clostridium difficile carriage and C. difficile-associated diarrhea in a cohort of hospitalized patients. J Infect Dis. 1990;162(3):678–84.PubMedCrossRef

16.

Aseeri M, Schroeder T, Kramer J, et al. Gastric acid suppression by proton pump inhibitors as a risk factor for clostridium difficile-associated diarrhea in hospitalized patients. Am J Gastroenterol. 2008;103(9):2308–13.PubMedCrossRef

17.

Keddis MT, Khanna S, Noheria A, et al. Clostridium difficile infection in patients with chronic kidney disease. Mayo Clin Proc. 2012;87(11):1046–53.PubMedCrossRef

18.

Shaughnessy MK, Micielli RL, DePestel DD, et al. Evaluation of hospital room assignment and acquisition of Clostridium difficile infection. Infect Control Hosp Epidemiol. 2011;32(3):201–6.PubMedCrossRef

19.

Pawar D, Tsay R, Nelson DS, et al. Burden of Clostridium difficile infection in long-term care facilities in Monroe County, New York. Infect Control Hosp Epidemiol. 2012;33(11):1107–12.PubMedCrossRef

20.

Kuntz JL, Johnson ES, Raebel MA, et al. Epidemiology and healthcare costs of incident Clostridium difficile infections identified in the outpatient healthcare setting. Infect Control Hosp Epidemiol. 2012;33(10):1031–8.PubMedCrossRef

21.

Hensgens MP, Goorhuis A, Dekkers OM, et al. All-cause and disease-specific mortality in hospitalized patients with Clostridium difficile infection: a multicenter cohort study. Clin Infect Dis. 2013;56(8):1108–16.PubMedCrossRef

22.

•• Zilberberg MD, Shorr AF, Micek ST, et al. Clostridium difficile-associated disease and mortality among the elderly critically ill. Crit Care Med. 2009 Jul 20. Retrospective review comparing characteristics and outcomes of the elderly vs. the younger groups, and elderly 30-day survivors with nonsurvivors.

23.

• Louie TJ, Miller MA, Crook DW, et al. Effect of age on treatment outcomes in Clostridium difficile infection. J Am Geriatr Soc. 2013;61(2):222–30. Randomized trial comparing vancomycin to fidaxomicin to examine the effects of age and study drug on outcomes of cure, and recurrence.PubMedCrossRef

24.

Pop-Vicas A, Shaban E, Letourneau C, et al. Empirical antimicrobial prescriptions in patients with Clostridium difficile infection at hospital admission and impact on clinical outcome. Infect Control Hosp Epidemiol. 2012;33(11):1101–6.PubMedCrossRef

25.

Elixhauser A, Steiner C, Gould C. Readmissions following hospitalizations with clostridium difficile infections, 2009: statistical brief #145. 2006 Feb.

26.

• Eyre DW, Walker AS, Wyllie D, et al. Predictors of first recurrence of Clostridium difficile infection: implications for initial management. Clin Infect Dis. 2012;55 Suppl 2:S77–87. Evaluated risk of recurrence in 1678 adults after their first episode of CDI; identified factors such as increasing age, initial disease severity, and hospital exposure.PubMedCrossRef

27.

Dubberke ER, Gerding DN, Classen D, et al. Strategies to prevent clostridium difficile infections in acute care hospitals. Infect Control Hosp Epidemiol. 2008;29 Suppl 1:S81–92.PubMedCrossRef

28.

Cohen SH, Gerding DN, Johnson S, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). Infect Control Hosp Epidemiol. 2010;31(5):431–55.PubMedCrossRef

29.

Kyne L, Merry C, O'Connell B, et al. Factors associated with prolonged symptoms and severe disease due to Clostridium difficile. Age Ageing. 1999;28(2):107–13.PubMedCrossRef

30.

Wilkins TD, Lyerly DM. Clostridium difficile testing: after 20 years, still challenging. J Clin Microbiol. 2003;41(2):531–4.PubMedCrossRef

31.

Stamper PD, Alcabasa R, Aird D, et al. Comparison of a commercial real-time PCR assay for tcdB detection to a cell culture cytotoxicity assay and toxigenic culture for direct detection of toxin-producing Clostridium difficile in clinical samples. J Clin Microbiol. 2009;47(2):373–8.PubMedCrossRef

32.

Bartlett JG, Gerding DN. Clinical recognition and diagnosis of Clostridium difficile infection. Clin Infect Dis. 2008;46 Suppl 1:S12–8.PubMedCrossRef

33.

Planche T, Aghaizu A, Holliman R, et al. Diagnosis of Clostridium difficile infection by toxin detection kits: a systematic review. Lancet Infect Dis. 2008;8(12):777–84.PubMedCrossRef

34.

Wilcox M. Overcoming barriers to effective recognition and diagnosis of Clostridium difficile infection. Clin Microbiol Infect. 2012;18(s6):13–20.PubMedCrossRef

35.

Ticehurst JR, Aird DZ, Dam LM, et al. Effective detection of toxigenic Clostridium difficile by a two-step algorithm including tests for antigen and cytotoxin. J Clin Microbiol. 2006;44(3):1145–9.PubMedCrossRef

36.

Fenner L, Widmer AF, Goy G, et al. Rapid and reliable diagnostic algorithm for detection of Clostridium difficile. J Clin Microbiol. 2008;46(1):328–30.PubMedCrossRef

37.

Wilcox MH. Overcoming barriers to effective recognition and diagnosis of Clostridium difficile infection. Clin Microbiol Infect. 2012;18 Suppl 6:13–20.PubMedCrossRef

38.

Fekety R, Silva J, Kauffman C, et al. Treatment of antibiotic-associated Clostridium difficile colitis with oral vancomycin: comparison of two dosage regimens. Am J Med. 1989;86(1):15–9.PubMedCrossRef

39.

McFarland LV, Elmer GW, Surawicz CM. Breaking the cycle: treatment strategies for 163 cases of recurrent Clostridium difficile disease. Am J Gastroenterol. 2002;97(7):1769–75.PubMedCrossRef

40.

Sethi Ajay K, Al-Nassir Wafa N, Nerandzic Michelle M, et al. Persistence of skin contamination and environmental shedding of Clostridium difficile during and after treatment of C. difficile infection. Infect Control Hosp Epidemiol. 2010;31(1):21–7.PubMedCrossRef

41.

Piche T, Vanbiervliet G, Pipau FG, et al. Low risk of irritable bowel syndrome after Clostridium difficile infection. Can J Gastroenterol. 2007;21(11):727–31.PubMed

42.

43.

Ryan J, Murphy C, Twomey C, et al. Asymptomatic carriage of Clostridium difficile in an Irish continuing care institution for the elderly: prevalence and characteristics. Ir J Med Sci. 2009 Jun 4.

44.

Simor AE, Bradley SF, Strausbaugh LJ, et al. Clostridium difficile in long-term-care facilities for the elderly. Infect Control Hosp Epidemiol. 2002;23(11):696–703.PubMedCrossRef

45.

Gerding DN, Muto CA, Owens Jr RC. Measures to control and prevent Clostridium difficile infection. Clin Infect Dis. 2008;46 Suppl 1:S43–9.PubMedCrossRef

46.

Owens Jr RC, Donskey CJ, Gaynes RP, et al. Antimicrobial-associated risk factors for Clostridium difficile infection. Clin Infect Dis. 2008;46 Suppl 1:S19–31.PubMedCrossRef

47.

Olson MM, Shanholtzer CJ, Lee Jr JT, et al. Ten years of prospective Clostridium difficile-associated disease surveillance and treatment at the Minneapolis VA Medical Center, 1982–1991. Infect Control Hosp Epidemiol. 1994;15(6):371–81.PubMedCrossRef

48.

Teasley DG, Gerding DN, Olson MM, et al. Prospective randomised trial of metronidazole versus vancomycin for Clostridium-difficile-associated diarrhoea and colitis. Lancet. 1983;2(8358):1043–6.PubMedCrossRef

49.

Horlen CK, Seifert CF, Malouf CS. Toxic metronidazole-induced MRI changes. Ann Pharmacother. 2000;34(11):1273–5.PubMedCrossRef

50.

Zar FA, Bakkanagari SR, Moorthi KM, et al. A comparison of vancomycin and metronidazole for the treatment of Clostridium difficile-associated diarrhea, stratified by disease severity. Clin Infect Dis. 2007;45(3):302–7.PubMedCrossRef

51.

Gerding DN. Metronidazole for Clostridium difficile-associated disease: is it okay for mom? Clin Infect Dis. 2005;40(11):1598–600.PubMedCrossRef

52.

Bartlett JG. The case for vancomycin as the preferred drug for treatment of Clostridium difficile infection. Clin Infect Dis. 2008;46(10):1489–92.PubMedCrossRef

53.

Cornely OA, Crook DW, Esposito R, et al. Fidaxomicin versus vancomycin for infection with Clostridium difficile in Europe, Canada, and the USA: a double-blind, non-inferiority, randomised controlled trial. Lancet Infect Dis. 2012;12(4):281–9.PubMedCrossRef

54.

Cornely OA, Miller MA, Louie TJ, et al. Treatment of first recurrence of Clostridium difficile infection: fidaxomicin versus vancomycin. Clin Infect Dis. 2012;55 Suppl 2:S154–61.PubMedCrossRef

55.

Mullane KM, Miller MA, Weiss K, et al. Efficacy of fidaxomicin versus vancomycin as therapy for Clostridium difficile infection in individuals taking concomitant antibiotics for other concurrent infections. Clin Infect Dis. 2011;53(5):440–7.PubMedCrossRef

56.

Louie TJ, Miller MA, Mullane KM, et al. Fidaxomicin versus vancomycin for Clostridium difficile infection. N Engl J Med. 2011;364(5):422–31.PubMedCrossRef

57.

Jaber MR, Olafsson S, Fung WL, et al. Clinical review of the management of fulminant clostridium difficile infection. Am J Gastroenterol. 2008;103(12):3195–203. quiz 204.PubMedCrossRef

58.

Lamontagne F, Labbe AC, Haeck O, et al. Impact of emergency colectomy on survival of patients with fulminant Clostridium difficile colitis during an epidemic caused by a hypervirulent strain. Ann Surg. 2007;245(2):267–72.PubMedCrossRef

59.

Neal MD, Alverdy JC, Hall DE, et al. Diverting loop ileostomy and colonic lavage: an alternative to total abdominal colectomy for the treatment of severe, complicated Clostridium difficile associated disease. Ann Surg. 2011;254(3):423–7. discussion 7–9.PubMedCrossRef

60.

Garey KW, Sethi S, Yadav Y, et al. Meta-analysis to assess risk factors for recurrent Clostridium difficile infection. J Hosp Infect. 2008;70(4):298–304.PubMedCrossRef

61.

Cober ED, Malani PN. Clostridium difficile infection in the "oldest" old: clinical outcomes in patients aged 80 and older. J Am Geriatr Soc. 2009;57(4):659–62.PubMedCrossRef

62.

Pepin J, Alary ME, Valiquette L, et al. Increasing risk of relapse after treatment of Clostridium difficile colitis in Quebec, Canada. Clin Infect Dis. 2005;40(11):1591–7.PubMedCrossRef

63.

Kelly CP, LaMont JT. Clostridium difficile–more difficult than ever. N Engl J Med. 2008;359(18):1932–40.PubMedCrossRef

64.

Brazier JS, Raybould R, Patel B, et al. Distribution and antimicrobial susceptibility patterns of Clostridium difficile PCR ribotypes in English hospitals, 2007–08. Euro Surveill. 2008 Oct 9;13(41).

65.

Kyne L, Warny M, Qamar A, et al. Association between antibody response to toxin A and protection against recurrent Clostridium difficile diarrhoea. Lancet. 2001;357(9251):189–93.PubMedCrossRef

66.

Leav BA, Blair B, Leney M, et al. Serum anti-toxin B antibody correlates with protection from recurrent Clostridium difficile infection (CDI). Vaccine. 2010;28(4):965–9.PubMedCrossRef

67.

Sullivan Å, Edlund C, Nord CE. Effect of antimicrobial agents on the ecological balance of human microflora. Lancet Infect Dis. 2001;1(2):101–14.PubMedCrossRef

68.

Figueroa I, Johnson S, Sambol SP, et al. Relapse versus reinfection: recurrent Clostridium difficile infection following treatment with fidaxomicin or vancomycin. Clin Infect Dis. 2012;55 suppl 2:S104–S9.PubMedCrossRef

69.

Segarra-Newnham M. Probiotics for Clostridium difficile-associated diarrhea: focus on Lactobacillus rhamnosus GG and Saccharomyces boulardii. Ann Pharmacother. 2007;41(7):1212–21.PubMedCrossRef

70.

Surawicz CM, McFarland LV, Greenberg RN, et al. The search for a better treatment for recurrent Clostridium difficile disease: use of high-dose vancomycin combined with Saccharomyces boulardii. Clin Infect Dis. 2000;31(4):1012–7.PubMedCrossRef

71.

Safdar N, Barigala R, Said A, et al. Feasibility and tolerability of probiotics for prevention of antibiotic-associated diarrhoea in hospitalized US military veterans. J Clin Pharm Ther. 2008;33(6):663–8.PubMedCrossRef

72.

Schwan A, Sjölin S, Trottestam U. Relapsing Clostridium difficile enterocolitis cured by rectal infusion of homologous faeces. Lancet. 1983;2(8354):845.PubMedCrossRef

73.

Gough E, Shaikh H, Manges AR. Systematic review of intestinal microbiota transplantation (fecal bacteriotherapy) for recurrent Clostridium difficile infection. Clin Infect Dis. 2011;53(10):994–1002.PubMedCrossRef

74.

Kelly CR, de Leon L, Jasutkar N. Fecal microbiota transplantation for relapsing Clostridium difficile infection in 26 patients: methodology and results. J Clin Gastroenterol. 2012;46(2):145–9.PubMedCrossRef

75.

Hamilton MJ, Weingarden AR, Sadowsky MJ, et al. Standardized frozen preparation for transplantation of fecal microbiota for recurrent Clostridium difficile infection. Am J Gastroenterol. 2012;107(5):761–7.PubMedCrossRef

76.

Kassam Z, Hundal R, Marshall JK, et al. Fecal transplant via retention enema for refractory or recurrent Clostridium difficile infection. Arch Intern Med. 2012;172(2):191–3 [Letter].PubMedCrossRef

77.

van Nood E, Vrieze A, Nieuwdorp M, et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. N Engl J Med. 2013;368(5):407–15.PubMedCrossRef

78.

Samore MH, Venkataraman L, DeGirolami PC, et al. Clinical and molecular epidemiology of sporadic and clustered cases of nosocomial Clostridium difficile diarrhea. Am J Med. 1996;100(1):32–40.PubMedCrossRef

79.

Fekety R, Kim KH, Brown D, et al. Epidemiology of antibiotic-associated colitis; isolation of Clostridium difficile from the hospital environment. Am J Med. 1981;70(4):906–8.PubMedCrossRef

80.

Muto CA, Blank MK, Marsh JW, et al. Control of an outbreak of infection with the hypervirulent Clostridium difficile BI strain in a university hospital using a comprehensive "bundle" approach. Clin Infect Dis. 2007;45(10):1266–73.PubMedCrossRef

81.

Weiss K, Boisvert A, Chagnon M, et al. Multipronged intervention strategy to control an outbreak of Clostridium difficile infection (CDI) and its impact on the rates of CDI from 2002 to 2007. Infect Control Hosp Epidemiol. 2009;30(2):156–62.PubMedCrossRef

82.

Vernaz N, Sax H, Pittet D, et al. Temporal effects of antibiotic use and hand rub consumption on the incidence of MRSA and Clostridium difficile. J Antimicrob Chemother. 2008;62(3):601–7.PubMedCrossRef

83.

Boyce JM, Ligi C, Kohan C, et al. Lack of association between the increased incidence of Clostridium difficile-associated disease and the increasing use of alcohol-based hand rubs. Infect Control Hosp Epidemiol. 2006;27(5):479–83.PubMedCrossRef

84.

Rupp ME, Fitzgerald T, Puumala S, et al. Prospective, controlled, cross-over trial of alcohol-based hand gel in critical care units. Infect Control Hosp Epidemiol. 2008;29(1):8–15.PubMedCrossRef

85.

Dellit TH, Owens RC, McGowan Jr JE, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007;44(2):159–77.PubMedCrossRef

Title: Changing Epidemiology and Control of Clostridium difficile in Older Adults
Authors: Natasha Bagdasarian
Krishna Rao
Preeti N. Malani
Publication date: 01-09-2013
Publisher: Springer US
Published in: Current Geriatrics Reports / Issue 3/2013
Electronic ISSN: 2196-7865
DOI: https://doi.org/10.1007/s13670-013-0049-2

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2013

Update on Dementia with Lewy Bodies

Issues Surrounding Antibiotic Use in Older Adults

Vascular Dementia

Emergence and Control of Antibiotic-resistant Gram-negative Bacilli in Older Adults

The Epidemiology and Clinical Impact of Surgical Site Infections in the Older Adult

Relationship of Gait and Cognition in the Elderly

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials