Skip to main content
SpringerLink
Log in

Clostridium difficile Infection: A Surgical Disease in Evolution

  • original article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

Several recent publications suggest an increase in the incidence of Clostridium difficile colitis. However, such studies commonly lack denominators over which to index this rise. There is also concern in the literature that disease virulence is increasing.

Methods

Billing, admission, operative, and infection databases at a single tertiary care center identified patients admitted from 1990 to 2006 with a diagnosis of C. difficile infection. Grouped by era, case numbers were indexed against overall hospital, operative, and laboratory volumes. C. difficile colectomy cases were individually examined and analyzed.

Results

The number of hospitalized patients diagnosed with C. difficile colitis increased in a linear fashion during the study period (1990, 14 cases; 2006, 927 cases). The colectomy per C. difficile case ratio did not change over the study period (era 1, 0.17%; era 2, 0.20%; era 3, 0.16%). Thirteen patients underwent colectomy with 54% surviving. The increase in patients admitted with a diagnosis of C. difficile was significantly associated with hospital volume (p = 0.04), operative volume (p < 0.001), and lab testing volume (p = 0.008).

Conclusion

The number of C. difficile patients admitted to our hospital is rising at an alarming rate. This reflects national trends and urgent action seems warranted to prevent a C. difficile epidemic.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Curry J, Hale BR, Talavero F, Pegoraro AA, Mylonakis E, Cunha BA. Pseudomembranous colitis. [emedicine web site]. July 20, 2007, 2007. Available at: http://www.emedicine.com/med/TOPIC1942.HTM#section~References. Accessed April 30, 2008.

  2. Wilkins TD. Chemotherapy of experimental anaerobic infections. J Antimicrob Chemother 1982;9:249–251 doi:10.1093/jac/9.4.249.

    Article  PubMed  CAS  Google Scholar 

  3. Goulston SJM, McGovern VJ. Pseudo-membranous colitis. Gut 1965;6:207–212 doi:10.1136/gut.6.3.207.

    Article  PubMed  CAS  Google Scholar 

  4. Smart RF, Ramsden DA, Gear MW, Nicol A, Lennox WM. Severe pseudomembranous colitis after lincomycin and clindamycin. Br J Surg 1976;63:25–29 doi:10.1002/bjs.1800630106.

    Article  PubMed  CAS  Google Scholar 

  5. Pothoulakis C, Lamont JT. Microbes and microbial toxins: paradigms for microbial–mucosal interactions II. The integrated response of the intestine to Clostridium difficile toxins. Am J Physiol Gastrointest Liver Physiol 2001;280:G178–83.

    PubMed  CAS  Google Scholar 

  6. Mylonakis E, Ryan ET, Calderwood SB. Clostridium difficile-associated diarrhea: a review. Arch Intern Med 2001;161:525–533 doi:10.1001/archinte.161.4.525.

    Article  PubMed  CAS  Google Scholar 

  7. Poutanen SM, Simor AE. Clostridium difficile-associated diarrhea in adults. CMAJ. 2004;171:51–58 doi:10.1503/cmaj.1031189.

    PubMed  Google Scholar 

  8. Muto CA, Pokrywka M, Shutt K, Mendelsohn AB, Nouri K, Posey K et al. A large outbreak of Clostridium difficile-associated disease with an unexpected proportion of deaths and colectomies at a teaching hospital following increased fluoroquinolone use. Infect Control Hosp Epidemiol 2005;26:273–280 doi:10.1086/502539.

    Article  PubMed  Google Scholar 

  9. McDonald LC, Killgore GE, Thompson A, Owens RC, Kazakova SV, Sambol SP et al. An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med 2005;353:2433–2441 doi:10.1056/NEJMoa051590.

    Article  PubMed  CAS  Google Scholar 

  10. Ricciardi R, Rothenberger DA, Madoff RD, Baxter NN. Increasing prevalence and severity of Clostridium difficile colitis in hospitalized patients in the United States. Arch Surg 2007;142:624–631. discussion 631 doi:10.1001/archsurg.142.7.624.

    Article  PubMed  Google Scholar 

  11. Johnson S, Clabots CR, Linn FV, Olson MM, Peterson LR, Gerding DN. Nosocomial Clostridium difficile colonisation and disease. Lancet 1990;336:97–100 doi:10.1016/0140-6736(90)91605-A.

    Article  PubMed  CAS  Google Scholar 

  12. Zerey M, Paton BL, Lincourt AE, Gersin KS, Kercher KW, Heniford BT. The burden of Clostridium difficile in surgical patients in the United States. Surg Infect (Larchmt) 2007;8:557–566 doi:10.1089/sur.2006.062.

    Article  Google Scholar 

  13. Boyce JM, Ligi C, Kohan C, Dumigan D, Havill NL. Lack of association between the increased incidence of Clostridium difficile-associated disease and the increasing use of alcohol-based hand rubs. Infect Control Hosp Epidemiol 2006;27:479–483 doi:10.1086/504362.

    Article  PubMed  Google Scholar 

  14. McFarland LV. Meta-analysis of probiotics for the prevention of antibiotic associated diarrhea and the treatment of Clostridium difficile disease. Am J Gastroenterol 2006;101:812–822 doi:10.1111/j.1572-0241.2006.00465.x.

    Article  PubMed  Google Scholar 

  15. Vesta KS, Wells PG, Gentry CA, Stipek WJ. Specific risk factors for Clostridium difficile-associated diarrhea: a prospective, multicenter, case control evaluation. Am J Infect Control 2005;33:469–472 doi:10.1016/j.ajic.2005.06.004.

    Article  PubMed  Google Scholar 

  16. Khurana A, Vinayek N, Recco RA, Go ES, Zaman MM. The incidence of Clostridium difficile-associated and non-C. difficile-associated diarrhea after use of gatifloxacin and levofloxacin in an acute-care facility. Clin Infect Dis 2004;39:602–603 doi:10.1086/422525.

    Article  PubMed  Google Scholar 

  17. Plummer S, Weaver MA, Harris JC, Dee P, Hunter J. Clostridium difficile pilot study: effects of probiotic supplementation on the incidence of C. difficile diarrhoea. Int Microbiol 2004;7:59–62.

    PubMed  Google Scholar 

  18. Wilcox MH, Freeman J, Fawley W, MacKinley S, Brown A, Donaldson K et al. Long-term surveillance of cefotaxime and piperacillin–tazobactam prescribing and incidence of Clostridium difficile diarrhoea. J Antimicrob Chemother 2004;54:168–172 doi:10.1093/jac/dkh285.

    Article  PubMed  CAS  Google Scholar 

  19. Thomas C, Riley TV. Restriction of third generation cephalosporin use reduces the incidence of Clostridium difficile-associated diarrhoea in hospitalised patients. Commun Dis Intell 2003;27(Suppl):S28–31.

    PubMed  Google Scholar 

  20. Privitera G, Scarpellini P, Ortisi G, Nicastro G, Nicolin R, de Lalla F. Prospective study of Clostridium difficile intestinal colonization and disease following single-dose antibiotic prophylaxis in surgery. Antimicrob Agents Chemother 1991;35:208–210.

    PubMed  CAS  Google Scholar 

  21. Wilcox MH, Fawley WN, Wigglesworth N, Parnell P, Verity P, Freeman J. Comparison of the effect of detergent versus hypochlorite cleaning on environmental contamination and incidence of Clostridium difficile infection. J Hosp Infect 2003;54:109–114 doi:10.1016/S0195-6701(02)00400-0.

    Article  PubMed  CAS  Google Scholar 

  22. Bettin K, Clabots C, Mathie P, Willard K, Gerding DN. Effectiveness of liquid soap vs. chlorhexidine gluconate for the removal of Clostridium difficile from bare hands and gloved hands. Infect Control Hosp Epidemiol 1994;15:697–702.

    PubMed  CAS  Google Scholar 

  23. Brooks SE, Veal RO, Kramer M, Dore L, Schupf N, Adachi M. Reduction in the incidence of Clostridium difficile-associated diarrhea in an acute care hospital and a skilled nursing facility following replacement of electronic thermometers with single-use disposables. Infect Control Hosp Epidemiol 1992;13:98–103.

    Article  PubMed  CAS  Google Scholar 

  24. Rao GG, Jeanes A, Ngo S, Wong J. Increased incidence of Clostridium difficile infection. J Hosp Infect 1997;37:252–254 doi:10.1016/S0195-6701(97)90255-3.

    Article  PubMed  CAS  Google Scholar 

  25. Boswell TC, Nye KJ, Smith EG. Increased incidence of Clostridium difficile infection. J Hosp Infect 1998;39:78–79 doi:10.1016/S0195-6701(98)90249-3.

    Article  PubMed  CAS  Google Scholar 

  26. Byrn JC, Maun DC, Gingold DS, Baril DT, Ozao JJ, Divino CM. Predictors of mortality after colectomy for fulminant Clostridium difficile colitis. Arch Surg 2008;143:150–4. discussion 155 doi:10.1001/archsurg.2007.46.

    Article  PubMed  Google Scholar 

  27. Climo MW, Israel DS, Wong ES, Williams D, Coudron P, Markowitz SM. Hospital-wide restriction of clindamycin: effect on the incidence of Clostridium difficile-associated diarrhea and cost. Ann Intern Med 1998;128:989–995.

    PubMed  CAS  Google Scholar 

  28. Ho M, Yang D, Wyle FA, Mulligan ME. Increased incidence of Clostridium difficile-associated diarrhea following decreased restriction of antibiotic use. Clin Infect Dis 1996;23(Suppl 1):S102–106.

    PubMed  Google Scholar 

  29. Thamlikitkul V, Danpakdi K, Chokloikaew S. Incidence of diarrhea and Clostridium difficile toxin in stools from hospitalized patients receiving clindamycin, beta-lactams, or nonantibiotic medications. J Clin Gastroenterol 1996;22:161–163 doi:10.1097/00004836-199603000-00024.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Veterans Administration Surgical Services, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA

    Kenneth A. Kudsk

  2. Department of Surgery, University of Wisconsin-Madison College of Medicine and Public Health, 600 Highland Avenue, H4/736 CSC, Madison, WI, 53792-7375, USA

    Joshua L. Hermsen, Cosmin Dobrescu & Kenneth A. Kudsk

Authors
  1. Joshua L. Hermsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cosmin Dobrescu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kenneth A. Kudsk
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kenneth A. Kudsk.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hermsen, J.L., Dobrescu, C. & Kudsk, K.A. Clostridium difficile Infection: A Surgical Disease in Evolution. J Gastrointest Surg 12, 1512–1517 (2008). https://doi.org/10.1007/s11605-008-0569-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-008-0569-9

Keywords

Search

Navigation