Autor:innen:
A. Kwetkat (Osnabrück , DE)
P. Franken (Jena, DE)
T. Lehmann (Jena, DE)
S. Golgert (Hamburg , DE)
U. Thiem (Hamburg , DE)
Introduction:
Clostridioides difficile is the main cause of infectious diarrhea in hospitalized patients. Although older adults and geriatric patients are at increased risk, associations of Clostridioides difficile infections (CdI) with morbidity, functional impairment and mortality have rarely been analyzed in geriatric inpatients. The aim of this study was to evaluate the burden of CdI in geriatric inpatients and its association with patients’ outcome parameters, i.e functional status on discharge and mortality.
Methods:
We used data of geriatric inpatients from the nationwide German database "GEMIDAS Pro" (GEriatric MInimum DAtaSet), originally established for the purpose of external quality assurance and benchmarking. German hospitals with acute geriatric departments, participating on a voluntary basis, provide data of geriatric inpatients annually. Data sets include, among others, the following variables: age, sex, primary and secondary diagnosis (as coded by ICD-10 codes), length of hospital stay, procedures, discharge status, and functional parameters like care dependency (as measured by the Barthel Index) and mobility (as measured by the Timed Up & Go Test). Inpatients with CdI were identified by any A04.7- ICD-10 code as principal or secondary discharge diagnosis. For analysis, we used data from 01/2008 until 12/2020. We calculated the CdI incidence annually for all inpatients. In univariate and multivariate analysis (by means of logistic regression), we assessed differences in functional status on discharge and mortality by CdI status.
Results:
We analyzed a total of 867,106 inpatients, mean age 82.5 ± 6.9 years, 584,975 females (67.5 %). Mean length of hospital stay was 18.1 ± 8 days, mean number of secondary diagnoses 13.2 ± 6.9. In total, 25,205 inpatients (3.1%) were identified as having CdI. The incidence of CdI increased from 17.7 (per 10,000 patient-days) in 2008 to a maximum of 22.65 (per 10,000 patient-days) in 2013. After 2015, the incidence steadily decreased, from 21.33 in 2015 to a minimum of 10.18 in 2019. On admission, 442,571 patients (51.0%) had mild to moderate care dependency, and 385,793 patients (44.5%) severe to very severe dependency. 355,907 patients (41.0%) were unable to walk. Overall, the intrahospital mortality was 3.1% (26,836 patients).
CdI positive inpatients were at increased risk for both mortality and loss of function at discharge. In univariate analysis, the odds ratio (OR) for the combined endpoint of death or missing improvement in dependency or missing recovery of mobility at discharge was 1.76 95% confidence interval (95% CI) [1.72 ; 1.81]. In multivariate analysis adjusting for age, sex and comorbidities, the OR was 1.67, 95% CI [1.63 ; 1.72]
Conclusions:
CdI is a relevant morbidity in the treatment of geriatric inpatients, increasing the risk for death or functional impairment. Because of its significant impact on function and survival, efforts to prevent CdI must be intensified.