Clostridioides Difficile and Frailty

"Within 5 weekdays from date of randomization (not included) a standardized CGA with a tailor-made intervention will be performed in the allocated ward or at home by a geriatric team. Bedside Multidimensional Prognostic Index (MPI) will be performed.~A geriatric Clostridioides difficile infection checklist will be performed by local geriatrician and secure an early assessment of CDI and treatment strategy.~When indication: pre-treatment with vancomycin 125 mg x 4. Routine biochemical analyses for patients with Clostridioides difficile infection.~Evaluation of indication for faecal microbiota transplantation (FMT).~Criteria for FMT rely on the geriatric assessment and will be considered for the patient if the patient fulfil one of the following:~1. Severe index, recurrent or refractory CDI as defined by national clinical guidelines or~2. High risk patient according to CGA at first visit. High risk patient is defined frailty grade MPI-2 (moderate) or MPI-3 (severe)."

"Continued specialized geriatric care through 8 weeks of follow-up. Minimum of follow-up is 8 weeks from last FMT or start of vancomycin/fidaxomicin treatment.~Tailormade telephone contacts and/or visits in case of clinical exacerbation. Performed by local geriatric teams.~The geriatric department remains responsible for the CDI during 8 weeks of follow-up or until cured."

When clinical indication for FMT, this will be delivered as 15-25 capsules (\~ 50 grams of donor faeces from one thoroughly screened healthy donor). If the patient is not admitted to hospital, FMT will be de-livered as home treatment via regional geriatric team or project manager and project nurse. If the patient has dysphagia diagnosed by dysphagia screening or carries a nasogastric tube, vancomycin and FMT can be delivered by naso-jejunal tube (Bengmark 10 Fr, Nutricia), requiring a referral to the Radiology department for verification of duodenal/jejunal tube placement. If available in the specific department, placement can be controlled via mobile x-ray.

Standard care: Patients are not contacted by the geriatric team. They receive usual treatment at the treating physician's discretion.