Predictors of Mortality and Morbidity in Clostridium Difficile Infection

Background: Clostridium Difficile (CD) is implicated in 20 to 30% of patients with antibiotic-associated diarrhoea, in 50 to 70% of those with antibiotic-associated colitis and in more than 90% of those with antibiotic-associated pseudomembranous colitis1-4. The incidence of CD associated diarrhoea ranges from 1 in 100 to 1 in 1,000 hospital discharges depending on the antibiotic prescribing habits of the hospital5-7. Aims: The primary objective of our study was to determine the baseline characteristics of in-patients with hospital acquired Clostridium difficile and to ascertain their eventual outcomes, and thus evaluate the effectiveness of disease severity in predicting mortality, morbidity at discharge and discharge destination. Secondary aims included an analysis of the epidemiology of the infected population and if antibiotic-related infection varied in prognosis to sporadic (antibiotic-unrelated) infection. Methods: All patients with diarrhoea admitted to a 24-bedded (cohort) ward in at Whiston Hospital, Merseyside – UK over a four week period (May 2008) were prospectively identified and their case-notes were retrospectively reviewed. Results: 16 patients with confirmed CD infection were identified during the period of the study. The mean age of the infected population was 80 years (age range: 59-89 years, median: 82 years). Discussion: The study confirms that CD is a disease that affects a predominantly elderly and frail population with multiple co-morbidities and poor performance status, and carries a large mortality and morbidity burden.