Department of Internal Medicine, Hospital Universitario de Mostoles, Faculty of Health Sciences, Universidad Rey Juan Carlos, Calle Doctor Luis Montes S/N, Mostoles, 28935, Madrid, Spain.
División of Infectious Disease and International Health, University of Virginia, Charlottesville, VA, USA.
Eur J Med Res. 2023 Oct 17;28(1):439. doi: 10.1186/s40001-023-01432-9.
Clostridioides difficile infection (CDI) is the leading cause of antibiotic-related diarrhea and healthcare-associated infections, affecting in particular elderly patients and their global health. This review updates the understanding of this infection, with focus on cognitive impairment and frailty as both risk factors and consequence of CDI, summarizing recent knowledge and potential mechanisms to this interplay.
A literature search was conducted including terms that would incorporate cognitive and functional impairment, aging, quality of life, morbidity and mortality with CDI, microbiome and the gut-brain axis.
Advanced age remains a critical risk for severe disease, recurrence, and mortality in CDI. Observational and quality of life studies show evidence of functional loss in older people after acute CDI. In turn, frailty and cognitive impairment are independent predictors of death following CDI. CDI has long-term impact in the elderly, leading to increased risk of readmissions and mortality even months after the acute event. Immune senescence and the aging microbiota are key in susceptibility to CDI, with factors including inflammation and exposure to luminal microbial products playing a role in the gut-brain axis.
Frailty and poor health status are risk factors for CDI in the elderly. CDI affects quality of life, cognition and functionality, contributing to a decline in patient health over time and leading to early and late mortality. Narrative synthesis of the evidence suggests a framework for viewing the cycle of functional and cognitive decline in the elderly with CDI, impacting the gut-brain and gut-muscle axes.
艰难梭菌感染（CDI）是抗生素相关性腹泻和医疗保健相关感染的主要原因，尤其影响老年患者及其全球健康。本综述更新了对这种感染的认识，重点关注认知障碍和衰弱既是 CDI 的风险因素，也是 CDI 的后果，并总结了最近对这种相互作用的认识和潜在机制。
进行了文献检索，包括将认知和功能障碍、衰老、生活质量、发病率和死亡率与 CDI、微生物组和肠-脑轴结合起来的术语。
高龄仍然是 CDI 发生严重疾病、复发和死亡的关键危险因素。观察性研究和生活质量研究表明，急性 CDI 后老年人存在功能丧失的证据。反过来，衰弱和认知障碍是 CDI 后死亡的独立预测因素。CDI 对老年人有长期影响，即使在急性事件发生后数月，也会导致再入院和死亡率增加。免疫衰老和衰老的微生物群是易患 CDI 的关键因素，包括炎症和暴露于腔微生物产物在内的因素在肠-脑轴中发挥作用。
衰弱和健康状况不佳是老年人 CDI 的危险因素。CDI 影响生活质量、认知和功能，随着时间的推移导致患者健康状况下降，并导致早期和晚期死亡。对证据的叙述性综合表明了一种框架，用于观察患有 CDI 的老年人的功能和认知下降周期，影响肠-脑和肠-肌肉轴。
