Interaction of Clostridioides difficile infection with frailty and cognition in the elderly: a narrative review

European Journal of Medical Research

Review

Maria-Jose Fernandez-Cotarelo¹  Cirle A. Warren²  Jasmine Y. Jackson-Akers³  Stephanie E. Nagy-Agren⁴ 

[1] 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;Division of Infectious Disease and International Health, University of Virginia, Charlottesville, VA, USA;División of Infectious Disease and International Health, University of Virginia, Charlottesville, VA, USA;Section of Infectious Diseases, Salem Veterans Affairs Medical Center, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA;

关键词: Clostridioides difficile;    Aging;    Microbiome;    Frailty;    Cognition;    Gut–brain axis;   

DOI  :  10.1186/s40001-023-01432-9

 received in 2023-02-18, accepted in 2023-10-05,  发布年份 2023

来源: Springer

【 摘 要 】

PurposeClostridioides 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.MethodsA 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.ResultsAdvanced 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.ConclusionsFrailty 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.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

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