Advertisement

Journal of Gastrointestinal Surgery

, Volume 18, Issue 10, pp 1804–1811 | Cite as

Clostridium difficile Infection After Colorectal Surgery: A Rare but Costly Complication

  • Rachelle N. Damle
  • Nicole B. Cherng
  • Julie M. Flahive
  • Jennifer S. Davids
  • Justin A. Maykel
  • Paul R. Sturrock
  • W. Brian Sweeney
  • Karim Alavi
Original Article

Abstract

Background

The incidence and virulence of Clostridium difficile infection (CDI) are on the rise. The characteristics of patients who develop CDI following colorectal resection have been infrequently studied.

Materials and Methods

We utilized the University HealthSystem Consortium database to identify adult patients undergoing colorectal surgery between 2008 and 2012. We examined the patient-related risk factors for CDI and 30-day outcomes related to its occurrence.

Results

A total of 84,648 patients met our inclusion criteria, of which the average age was 60 years and 50 % were female. CDI occurred in 1,266 (1.5 %) patients during the years under study. The strongest predictors of CDI were emergent procedure, inflammatory bowel disease (IBD), and major/extreme APR-DRG severity of illness score. CDI was associated with a higher rate of complications, intensive care unit (ICU) admission, longer preoperative inpatient stay, 30-day readmission rate, and death within 30 days compared to non-CDI patients. Cost of the index stay was, on average, $14,130 higher for CDI patients compared with non-CDI patients.

Conclusion

Emergent procedures, higher severity of illness, and inflammatory bowel disease are significant risk factors for postoperative CDI in patients undergoing colorectal surgery. Once established, CDI is associated with worse outcomes and higher costs. The poor outcomes of these patients and increased costs highlight the importance of prevention strategies targeting high-risk patients.

Keywords

Outcomes research Cost analysis Colon and rectal surgery 

References

  1. 1.
    Zilberberg MD, Shorr AF, Kollef MH. Increase in adult Clostridium difficile-related hospitalizations and case-fatality rate, United States, 2000-2005. Emerg Infect Dis. 2008;14:929-931.PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    Kyne L, Hamel MB, Polavaram R, Kelly CP. Health care costs and mortality associated with nosocomial diarrhea due to Clostridium difficile. Clin Infect Dis. 2002;34:346-353.PubMedCrossRefGoogle Scholar
  3. 3.
    Zerey M, Paton BL, Lincourt AE, Gersin KS, Kercher KW, Heniford BT. The burden of Clostridium difficile in surgical patients in the United States. Surgical infections. 2007;8:557-566.PubMedCrossRefGoogle Scholar
  4. 4.
    O’Brien JA, Lahue BJ, Caro JJ, Davidson DM. The emerging infectious challenge of clostridium difficile-associated disease in Massachusetts hospitals: clinical and economic consequences. Infect Control Hosp Epidemiol. 2007;28:1219-1227.PubMedCrossRefGoogle Scholar
  5. 5.
    Barbut F, Petit J. Epidemiology of Clostridium difficile-associated infections. Clinical Microbiology and Infection. 2001;7:405-410.PubMedCrossRefGoogle Scholar
  6. 6.
    Bignardi GE. Risk factors for <i> Clostridium difficile infection. Journal of Hospital Infection. 1998;40:1-15.PubMedCrossRefGoogle Scholar
  7. 7.
    McFarland LV, Mulligan ME, Kwok RYY, Stamm WE. Nosocomial acquisition of Clostridium difficile infection. New England journal of medicine. 1989;320:204-210.PubMedCrossRefGoogle Scholar
  8. 8.
    Halabi WJ, Nguyen VQ, Carmichael JC, Pigazzi A, Stamos MJ, Mills S. Clostridium difficile colitis in the United States: a decade of trends, outcomes, risk factors for colectomy, and mortality after colectomy. J Am Coll Surg. 2013;217:802-812.PubMedCrossRefGoogle Scholar
  9. 9.
    Redelings MD, Sorvillo F, Mascola L. Increase in Clostridium difficile–related mortality rates, United States, 1999–2004. Emerging infectious diseases. 2007;13:1417.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Brown E, Talbot GH, Axelrod P, Provencher M, Hoegg C. Risk factors for clostridium difficile toxin-associated diarrhea. Infection Control and Hospital Epidemiology. 1990;11:283-290.PubMedCrossRefGoogle Scholar
  11. 11.
    Lundeen SJ, Otterson MF, Binion DG, Carman ET, Peppard WJ. Clostridium difficile enteritis: an early postoperative complication in inflammatory bowel disease patients after colectomy. Journal of Gastrointestinal Surgery. 2007;11:138-142.PubMedCrossRefGoogle Scholar
  12. 12.
    Krapohl GL, Morris AM, Cai S, Englesbe MJ, Aronoff DM, Campbell DAJ, Hendren S. Preoperative risk factors for postoperative Clostridium difficile infection in colectomy patients. Am J Surg. 2013;205:343-7; discussion 347.PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Wren SM, Ahmed N, Jamal A, Safadi BY. Preoperative oral antibiotics in colorectal surgery increase the rate of Clostridium difficile colitis. Arch Surg. 2005;140:752-756.PubMedCrossRefGoogle Scholar
  14. 14.
    Goodhand JR, Alazawi W, Rampton DS. Systematic review: Clostridium difficile and inflammatory bowel disease. Aliment Pharmacol Ther. 2011;33:428-441.PubMedCrossRefGoogle Scholar
  15. 15.
    Kent KC, Rubin MS, Wroblewski L, Hanff PA, Silen W. The impact of Clostridium difficile on a surgical service: a prospective study of 374 patients. Ann Surg. 1998;227:296-301.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Buendgens L, Bruensing J, Matthes M, Duckers H, Luedde T, Trautwein C, Tacke F, Koch A. Administration of proton pump inhibitors in critically ill medical patients is associated with increased risk of developing Clostridium difficile-associated diarrhea. J Crit Care. 2014Google Scholar
  17. 17.
    Jayatilaka S, Shakov R, Eddi R, Bakaj G, Baddoura WJ, DeBari VA. Clostridium difficile infection in an urban medical center: five-year analysis of infection rates among adult admissions and association with the use of proton pump inhibitors. Ann Clin Lab Sci. 2007;37:241-247.PubMedGoogle Scholar
  18. 18.
    Lesperance K, Causey MW, Spencer M, Steele SR. The morbidity of <i> Clostridium difficile infection after elective colonic resection—results from a national population database. The American Journal of Surgery. 2011;201:141-148.CrossRefGoogle Scholar
  19. 19.
    Sammon J, Trinh VQ, Ravi P, Sukumar S, Gervais MK, Shariat SF, Larouche A, Tian Z, Kim SP, Kowalczyk KJ, Hu JC, Menon M, Karakiewicz PI, Trinh QD, Sun M. Health care-associated infections after major cancer surgery: temporal trends, patterns of care, and effect on mortality. Cancer. 2013;119:2317-2324.PubMedCrossRefGoogle Scholar
  20. 20.
    Roetzheim RG, Pal N, Gonzalez EC, Ferrante JM, Van Durme DJ, Krischer JP. Effects of health insurance and race on colorectal cancer treatments and outcomes. Am J Public Health. 2000;90:1746-1754.PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Sun C, Du P, Wu XR, Queener E, Shen B. Preoperative Clostridium difficile Infection Is Not Associated with an Increased Risk for the Infection in Ileal Pouch Patients. Dig Dis Sci. 2014Google Scholar
  22. 22.
    Ghantoji SS, Sail K, Lairson DR, DuPont HL, Garey KW. Economic healthcare costs of Clostridium difficile infection: a systematic review. J Hosp Infect. 2010;74:309-318.PubMedCrossRefGoogle Scholar
  23. 23.
    Karas JA, Enoch DA, Aliyu SH. A review of mortality due to Clostridium difficile infection. J Infect. 2010;61:1-8.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2014

Authors and Affiliations

  • Rachelle N. Damle
    • 1
  • Nicole B. Cherng
    • 1
  • Julie M. Flahive
    • 2
  • Jennifer S. Davids
    • 3
  • Justin A. Maykel
    • 3
  • Paul R. Sturrock
    • 3
  • W. Brian Sweeney
    • 3
  • Karim Alavi
    • 3
  1. 1.Department of SurgeryUniversity of Massachusetts Medical CenterWorcesterUSA
  2. 2.Center for Outcomes Research, Department of SurgeryUniversity of Massachusetts Medical CenterWorcesterUSA
  3. 3.Division of Colorectal SurgeryUniversity of Massachusetts Medical CenterWorcesterUSA

Personalised recommendations