Déterminer les facteurs de risque de mortalité à 3 mois des patients âgés de plus de 75 ans atteints d’une infection à Clostridium Difficile, hospitalisés au Centre Hospitalier Universitaire de Nice

Abstract : Introduction: Clostridium difficile infection (CDI) is one of the leading causes of antibiotic diarrhea and healthcare-associated infections. With increased morbidity factors, the frail elderly person is particularly vulnerable. More frequent, more severe and often refractory to treatment standards, the prevention of CDI is a major issue during hospitalization of geriatric patients. The objective of the study was to define the risk factors for mortality of patients over 75 years with Clostridium Difficile infection.
Materials and methods: Cohort study, observational, prospective, was in progress during the period from January 1, 2016 to November 30, 2017 at Nice University Hospital. The included patients were older than 75 years and had a diagnosis of CDI. For each patient, infectious, clinical and demographic data were collected.
Results: 66 patients were included, mean age 85.8 years [75 -98 years]. 77.3% were women (n = 51), 89.4% from home (n = 59), with an average weighted Charlson score of 7.6 [4-14]. 65.2% (n = 43) had impaired independence and 75.8% were malnourished (n = 50). Of these, 72.7% (n = 48) received antibiotic therapy during hospitalization. The average ATLAS score is 4.8 [1-9]. The recurrence rate is 16% (n = 24.2), 17% of deaths during hospitalization (n = 25.8) and 39.4% of deaths at 3 months (n = 26). Analysis shows an association between ICD and male sex (p = 0.002), solid or hematologic neoplastic pathology treated or not (p = 0.044), impairment of autonomy (p = 0.016), albumin (p = 0.016) on mortality at 3 month. In multivariate analysis, male sex (p = 0.028, OR 5.457) and neoplastic pathologies (p = 0.027, OR 4.668) and albumin (p = 0.021 OR 0.855) are major factors associated.
Conclusion: Our study found that male sex, history of cancer and hypoalbuminemia were risk factors for 3-month mortality in patients aged 75 years and older with Clostridium Difficile infection. These three factors show the importance of the prevention of this infectious pathology at the level of the development factors with, at the forefront, a precautionary and adapted use of antibiotherapy, screening with an early treatment and the respect of hygiene rules in order to reduce the risk of transmission.
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Master Thesis
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Claire Chennesseau. Déterminer les facteurs de risque de mortalité à 3 mois des patients âgés de plus de 75 ans atteints d’une infection à Clostridium Difficile, hospitalisés au Centre Hospitalier Universitaire de Nice. Médecine humaine et pathologie. 2018. ⟨dumas-01975589⟩

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