Using faecal microbiota transplantation within the CGA framework further enhanced survival and care efficiency.
C diff infection
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A recent randomized trial published in The Lancet found that early comprehensive geriatric assessment (CGA) improves outcomes for older patients with Clostridioides difficile infection (CDI). The study in Denmark included 217 patients aged 70 and older. CGA reduced CDI recurrence, hospital readmissions, and hospital stay duration compared to standard care. While there was no significant difference in 90-day mortality between the two groups, secondary outcomes were better in the CGA group.
Both groups had equal access to faecal microbiota transplantation (FMT), a treatment known to reduce CDI mortality. Early use of FMT in the CGA group was associated with lower 90-day mortality and fewer deaths directly attributed to CDI. Of the 16 deaths in the CGA group, 7 (44%) were from CDI, compared to 18 (82%) of 22 deaths in the standard-care group. "The reduced CDI recurrence, readmission, and in-hospital days associated with CGA suggest improvement of the overall patient care continuum," the investigators stated. This suggests that the CGA pathway, which included early FMT and tailored care, improved clinical outcomes and reduced the burden on hospital resources by preventing unnecessary readmissions.1
The positive results may be due to the timely administration of FMT in the CGA group. Patients in this group received FMT earlier and, in some cases, even in their homes. The ability to manage treatment at home, rather than in the hospital, also appears to have played an important role in improving patient outcomes. The study suggests that CGA can help streamline the care process, preventing unnecessary hospital stays and readmissions, while improving patient satisfaction and safety.1
In addition to its clinical benefits, the CGA approach was shown to be highly feasible, with no patients declining the intervention. The study also demonstrated that home-based FMT treatment could be effectively incorporated into geriatric care, offering a less disruptive option for patients. As investigators noted, “The efficacy of the geriatric intervention relies on prompt and specialized assessment by a multidisciplinary team and unrestricted access to FMT."1
Early CGA significantly reduced CDI recurrence, hospital readmissions, and hospital stay duration in older patients.
Early use of FMT in the CGA group led to decreased 90-day mortality and fewer deaths from CDI.
The study demonstrated that home-based FMT treatment was effective and feasible as part of the CGA approach for managing older patients with CDI.
The study has limitations. The sample size calculation was based on cohorts with higher mortality, and the lower mortality in this study may reflect improvements in standard care, including increased use of FMT. The study also did not fully account for socioeconomic factors, and all participants were White, which may limit generalizability. Despite these limitations, the study supports the idea that CGA and FMT are complementary, with CGA-based care planning being essential for the success of FMT, particularly in home-based treatment.1
The CDC highlights that older adults, specifically those aged 65 or older, are at higher risk for CDIs. Individuals in this age group who are diagnosed with a healthcare-associated CDI face a significant risk of mortality, with one in 11 dying within one month of diagnosis. This increased risk is associated with several factors, including weakened immune systems, previous CDIs, and the frequent use of antibiotics. Older adults are particularly vulnerable in healthcare settings, such as hospitals and nursing homes, where C diff is more prevalent.2
In conclusion, this trial showed that integrating CGA into managing older patients with CDI improves outcomes, including reduced infection recurrence, hospital readmissions, and CDI-related mortality. The use of FMT within the CGA framework improved survival and care efficiency. These results support the adoption of CGA as a standard treatment approach for older patients with CDI, while further research is needed to assess the long-term cost-effectiveness of home-based FMT.
