Abstract
Clostridium difficile infection (CDI) is the most frequent cause of nococomial diarrhoea. Most cases are succesfully treated by antibiotic therapy, but nearly 10% may progress to the fulminant form. The aim of this work is a retrospective evaluation of the results of surgical treatment of patients with the severe Costridium colitis, in the period 2008-2014. Clostridium toxins were detected in patients in Bohunice University Hospital in 1956. Thirty seven of them underwent surgery due to toxic colitis. There were 6 total colectomies with terminal ileostomy, 29 subtotal colectomies with terminal ileostomy, 1 coecostomy and 1 axial ileostomy. The 30-day mortality was nearly 35 %, 90- day mortality 54% and morbidity 89%. Early and precise indication for surgery could save about 65% of patients with fulminant course of Clostridium difficile colitis.
Highlights
In recent years, C. difficile infections (CDI) have become more frequent, more severe and more diffucult to treat
In this retrospective study we evaluated the operative treatment of patients with the fulminant form of Clostridium difficile colitis at the Surgical department of University Hospital Brno and Faculty of Medicine of Masaryk University Brno, in the period from January 2008 to December 2014
Between 2008 and 2014, positive Clostridium toxins A or B were found in a total of 1.956 patients hospitalised at the University Hospital Brno
Summary
C. difficile infections (CDI) have become more frequent, more severe and more diffucult to treat. C.difficile is a gram-positive sporulating anaerobic bacillus (spors can survive up to 5 months). It produces toxins A and B causing mucosal destruction and pseudomembrane formation [1,2,3,4,5]. The prevalence of CDIassociated colitis has been increasing and there is a growing number of recurrent infections, refractory to standard therapy. We can find positive toxins in faeces of 3-5% of adult population and in 10-25% of hospitalised patients; it becomes more often up to 25% after therapy with antibiotics (ATB). Similar numbers were found in patients who received one dose of prophylactic antibiotics before surgical procedure [6]
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