C. difficile raises risk of death, long-term care for seniors

Clostridium difficile infections are a major driver of death and nursing home placement in Americans older than 65 years, according to research presented at a major international conference on infectious diseases.

A Medicare database review of almost 1.6 million patients has determined that 36 percent of those with C. difficile died, compared with 25 percent of an age matched control group – an 11 percent attributable mortality. The infections also doubled the risk of placement in a skilled care nursing facility and tripled the risk of nursing home admission. It was said at the European Society of Clinical Microbiology and Infectious Diseases annual congress.

An infectious disease specialist at Washington University St. Louis, said these findings underscore not only the infection’s potential lethality, but its considerable impact on both short- and long-term quality of life.

Case-control study included 175,000 patients older than 65 years who were diagnosed with C. difficile infection in 2011 – they were then matched with 1.45 million controls. This yielded 129,000 pairs matched for mortality, 105,000 matched for skilled nursing facility admission, and 93,500 matched for nursing home admission. The analysis controlled for age, gender, race, and other infections, as well as health care utilizations and a comprehensive group of acute and chronic conditions in the prior 12 months.

Overall, it was found out that 36 percent of cases and 35 percent of controls died during the year – a 44 percent increased risk of death and an 11 percent attributable mortality rate. During the same period, another 36 percent of the C. difficile cases were admitted to a skilled nursing facility, compared with 19 percent of controls – an 89 percent increased risk and 17 percent attributable admission rate.

C. difficile infections also exerted a significant impact on nursing home admissions: 15 percent if the cases in the study were admitted compared with 5 percent of controls. This represented almost a tripling of risk, with an attributable admission rate of 10 percent.

“These findings illustrate C. difficile impacts quality of life, with short-term morbidity reflected in increasing admissions to skilled nursing facilities, and long-term morbidity by increasing admissions to nursing homes.”