Clostridium difficile Infection: Which Surgical Patients Are at Highest Risk?

Clostridium difficile infection is the most common hospital-acquired infection and a significant cause of increased hospital stay and cost for patients and payors alike. In the May issue of Diseases of the Colon & Rectum, surgeons from George Washington University Hospital sought to identify rates of C. difficile infection in patients undergoing common types of colon operations. These included both elective colon resection as well as closure of temporary stomas.

In order to do this, the authors utilized the American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) and targeted colectomy database for 2015. They identified over 2200 patients who had undergone elective stoma reversal and more than 10,000 patients who had undergone elective colon resection. Patients undergoing stoma reversal had a significantly higher rate of C. difficile infection in the first 30 postoperative day period than those undergoing colon resection (3.04% versus 1.25%, respectively).

The authors identified that stoma reversal, smoking, steroid use, and disseminated cancer were all associated with a higher rate of postoperative C. difficile infection.

Author Matthew Skancke said, "We believe that our data presents compelling evidence of the increased incidence of postoperative Clostridium difficile in patients following ileostomy or colostomy reversal."

Reference: Skancke M, Vaziri K, Umapathi B, Amdur R, Radomski M, Obias V. Elective Stoma Reversal Has a Higher Incidence of Postoperative Clostridium Difficile Infection Compared With Elective Colectomy: An Analysis Using the American College of Surgeons National Surgical Quality Improvement Program and Targeted Colectomy Databases. Diseases of the Colon & Rectum: May 2018 - Volume 61 - Issue 5 - p 593–598. doi: 10.1097/DCR.0000000000001041

Source: Diseases of the Colon and Rectum Journal