Clostridium Difficile Colitis In Patients Research Articles

Clostridium difficile colitis in patients undergoing surgery for hip fractures: an analysis of 17,474 patients.

We compiled evidence from a large national surgical database to identify the incidence, risk factors and postoperative impact of Clostridium difficile infection (CDI) in patients undergoing hip fracture repair. We identified 17,474 patients who underwent hip fracture repairs in 2015 using the ACS-NSQIP database. Interventions studied were open reduction/Internal fixation, total hip arthroplasty or hemiarthroplasty being performed for traumatic hip fractures. Outcomes studied were incidence, preoperative and postoperative risk factors for occurrence of CDI were studied using descriptive and statistical analysis. A total of 92 patients (0.53%) developed CDI within 30 days of the operation. Following adjustment using multi-variate logistic regression, preoperative and hospital-associated factors associated with development of CDI were smoking (OR 1.75 [95% CI 1.03-2.99]), hypertension (OR 1.70 [95% CI 1.01-2.85]), hyponatraemia (OR 1.65 [95% CI 1.04-2.63]), prior systemic inflammatory response syndrome (SIRS) (OR 2.18 [95% CI 1.32-3.59]) and a length of stay >7 days (OR 1.98 [95% CI 1.11-3.53]. Postoperative factors associated with occurrence of CDI were occurrence of a deep surgical site infection (SSI) (OR 5.89 [95% CI 1.31-26.6]), a stay in the hospital >30 days (OR 6.56 [95% CI 2.56-16.9]) and unplanned reoperations (OR 2.78 [95% CI 1.29-5.99]). As we move toward an era of bundled-payment models, identification of risk factors associated with the occurrence of postoperative complications, such as CDI, will help curb excess healthcare utilisation and costs associated with the management of this complication.

Risk Factors and Costs Associated With Clostridium difficile Colitis in Patients With Prosthetic Joint Infection Undergoing Revision Total Hip Arthroplasty

BackgroundWith the increased demand for primary total hip arthroplasty (THA) and corresponding rise in revision procedures, it is imperative to understand the factors contributing to the development of Clostridium difficile colitis. We aimed to provide a detailed analysis of: (1) the incidence of; (2) the demographics, lengths of stay, and total costs for; and (3) the risk factors and mortality associated with the development of C. difficile colitis after revision THA. MethodsThe National Inpatient Sample database was queried for all individuals diagnosed with a periprosthetic joint infection and who underwent all-component revision THA between 2009 and 2013 (n = 40,876). Patients who developed C. difficile colitis during their inpatient hospital stay were identified. Multilevel logistic regression analysis was conducted to assess the association between hospital- and patient-specific characteristics and the development of C. difficile colitis. ResultsThe overall incidence of C. difficile colitis after revision THA was 1.7%. These patients were significantly older (74 vs 65 years), had greater lengths of hospital stay (19 vs 9 days), accumulated greater costs ($51,641 vs $28,282), and were more often treated in an urban hospital compared to their counterparts who did not develop C. difficile colitis (P < .001 for all). Patients with colitis also had a significantly higher in-hospital mortality compared to those without (5.6% vs 1.4%; P < .001). ConclusionWhile C. difficile colitis infection is an uncommon event following revision THA, it can have potentially devastating consequences. Our analysis demonstrates that this infection is associated with a longer hospital stay, higher costs, and greater in-hospital mortality.

MP56-04 THE MEDIUM TERM OUTCOMES OF STOMA FORMATION FOR PATIENTS UNDERGOING CONDUIT DIVERSION FOR FUNCTIONAL AETIOLOGY: 5 YEAR FOLLOW-UP

INTRODUCTION AND OBJECTIVES: Clostridium difficile (CD) colitis is at historically high levels, leading to increased complications and costs in patients undergoing major abdominal surgery involving the gastrointestinal tract. We sought to assess if screening and empiric treatment of preoperative asymptomatic CD carriers would decrease symptomatic CD colitis in patients undergoing cystectomy and urinary diversion METHODS: A prospective evaluation of CD carrier status was undertaken in patients undergoing cystectomy and urinary diversion between January-September 2015 by testing stool samples at the time of surgery. Patients identified as CD carriers were treated with intravenous metronidazole until return of bowel function. The incidence of clinically symptomatic CD colitis was assessed in this intention to treat cohort and compared to a retrospective cohort of 562 patients that underwent cystectomy during 2010-2013. RESULTS: A total of 78 patients were included in the intention to treat analysis, of which 62 (79%) were screened intraoperatively for CD. Of those screened, 18 (30%) were asymptomatic carriers of CD. The incidence of patients who developed symptomatic CD colitis in the intention to treat cohort was 3.8% (3/78 patients). Of those 3 patients, 2 were negative for CD preoperatively and 1 was unknown. None of the treated patients developed CD colitis or adverse outcomes. When compared to the historical cohort which had aCD colitis incidence of 8.8%, the relative risk reduction was 57% with a number needed to treat of 20. CONCLUSIONS: Cystectomy patients were found to have a high incidence of asymptomatic CD. Identification and treatment of asymptomatic carriers at time of surgery seems to decrease the incidence of CD colitis. Further studies are warranted to assess the utility and cost of testing for CD status followed with empiric treatment.

Mo1818 Effect of Aging on the Fecal Microbiome in Healthy Donors for Fecal Microbiota Transplant

Background: Fecal microbiota transplant (FMT) is fast emerging as a promising therapy for recurrent clostridium difficile colitis in patients not responding to antibiotic therapy. However all patients for FMT need a fecal sample from a healthy donor. However the effect of age on the fecal microbiome of the healthy donor and its clinical efficacy, has not been examined previously. Aim: To examine fecal samples of healthy human subjects of various ages, volunteering to donate their samples for FMT by genomic analysis and clinical outcom. Methods: All healthy subjects who were rigorously screened for infectious disease and selected as donors for FMT were included in the study. Fecal samples were processed and analyzed using 16S rRNA gene amplicon sequencing. Microbiota compositions were studied using standard 16S rRNA analysis tools (CloVR-16S). Differences in bacterial phylum abundance and diversity (Shannon index) of the donor fecal microbiota were analyzed using three different cutoff for age of 50 years, 60 years and 70 years. Effect of fecal microbiota from donors of different age groups on efficacy of FMT in patients with RCDI was monitored in the GI clinic. Results: Fecal microbiota of 30 healthy donors was analyzed. The mean age of the donors was 50±15.3 years and ranged between 20 years to 82 years. Of these 30 donors, 18 (60%) were males and 26 (87%) were related to the recipients. The Shannon index did demonstrate significant increase in the fecal microbiome diversity in 70+ year old donors, as demonstrated in Figure 1. Althoughmicrobiome dissimilarity between the younger donors groups was relatively larger than the older donors groups on weighted UniFrac metric analysis, the association was not statistically significant. At phylum level, while the relative abundance of Firmicutes was higher in older groups (p<0.05), Actinobacteria was higher in younger groups (p<0.05). At family and genus level, the relative abundance of bifidobactericeae members were higher in younger group of donors than older group (p<0.05). However, despite these genomic differences in the fecal microbiota with ageing, all of our patients recovered completely from the recurrent clostridium difficile infection. Conclusion: This data suggests that there is a trend towards increase in relative abundance of Firmicutes with ageing. Furthermore the younger subjects were more dissimilar by measuring phylogenetic distances than the older donors. These observations indicate that human fecal microbiome evolves with ageing process and associated factors.

Mo1820 Activation of the GCN2/eIF2alpha/ATF4 Signaling Pathway Triggers Autophagy Response to Infection With Crohn's Disease-Associated Adherent-Invasive Escherichia coli

Background: Fecal microbiota transplant (FMT) is fast emerging as a promising therapy for recurrent clostridium difficile colitis in patients not responding to antibiotic therapy. However all patients for FMT need a fecal sample from a healthy donor. However the effect of age on the fecal microbiome of the healthy donor and its clinical efficacy, has not been examined previously. Aim: To examine fecal samples of healthy human subjects of various ages, volunteering to donate their samples for FMT by genomic analysis and clinical outcom. Methods: All healthy subjects who were rigorously screened for infectious disease and selected as donors for FMT were included in the study. Fecal samples were processed and analyzed using 16S rRNA gene amplicon sequencing. Microbiota compositions were studied using standard 16S rRNA analysis tools (CloVR-16S). Differences in bacterial phylum abundance and diversity (Shannon index) of the donor fecal microbiota were analyzed using three different cutoff for age of 50 years, 60 years and 70 years. Effect of fecal microbiota from donors of different age groups on efficacy of FMT in patients with RCDI was monitored in the GI clinic. Results: Fecal microbiota of 30 healthy donors was analyzed. The mean age of the donors was 50±15.3 years and ranged between 20 years to 82 years. Of these 30 donors, 18 (60%) were males and 26 (87%) were related to the recipients. The Shannon index did demonstrate significant increase in the fecal microbiome diversity in 70+ year old donors, as demonstrated in Figure 1. Althoughmicrobiome dissimilarity between the younger donors groups was relatively larger than the older donors groups on weighted UniFrac metric analysis, the association was not statistically significant. At phylum level, while the relative abundance of Firmicutes was higher in older groups (p<0.05), Actinobacteria was higher in younger groups (p<0.05). At family and genus level, the relative abundance of bifidobactericeae members were higher in younger group of donors than older group (p<0.05). However, despite these genomic differences in the fecal microbiota with ageing, all of our patients recovered completely from the recurrent clostridium difficile infection. Conclusion: This data suggests that there is a trend towards increase in relative abundance of Firmicutes with ageing. Furthermore the younger subjects were more dissimilar by measuring phylogenetic distances than the older donors. These observations indicate that human fecal microbiome evolves with ageing process and associated factors.

Specific features of clostridium difficile colitis in patients with inflammatory bowel disease

Through its specific biological, epidemiological, diagnostic and infection management features, Clostridium difficile infection (CDI) can be considered a major health concern, especially in inflammatory bowel disease (IBD) patients. In this particular infection, many IBD risk factors are triggered due to bowel inflammation, antibiotics use, microbiota changes, immunosuppressive therapy use and surgical intervention. Thus, each IBD and diarrhea patient must be tested for CDI. Clinical features show different initial infectious stages such as mild, fulminate and refractory. It has been shown that CDI presents recurrent episodes. CDI treatment consists of metronidazole, vancomycin or fidaxomicin, as well as prophylactic measures. It was recently shown that antibiotic doses must be gradually reduced in order to avoid CDI relapses. Fecal transplantation, effective in CDI management, remains controversial in CDI patients with concurrent IBD.

Clostridium difficile colitis in patients undergoing lumbar spine surgery.

Retrospective database analysis. To investigate incidence, comorbidities, and impact on health care resources of Clostridium difficile infection after lumbar spine surgery. C. difficile colitis is reportedly increasing in hospitalized patients and can have a negative impact on patient outcomes. No data exist on estimates of C. difficile infection rates and its consequences on patient outcomes and health care resources among patients undergoing lumbar spine surgery. The Nationwide Inpatient Sample was examined from 2002 to 2011. Patients were included for study based on International Classification of Diseases, Ninth Revision, Clinical Modification, procedural codes for lumbar spine surgery for degenerative diagnoses. Baseline patient characteristics were determined and multivariable analyses assessed factors associated with increased incidence of C. difficile and risk of mortality. The incidence of C. difficile infection in patients undergoing lumbar spine surgery is 0.11%. At baseline, patients infected with C. difficile were significantly older (65.4 yr vs. 58.9 yr, P<0.0001) and more likely to have diabetes with chronic complications, neurological complications, congestive heart failure, pulmonary disorders, coagulopathy, and renal failure. Lumbar fusion (P=0.0001) and lumbar fusion revision (P=0.0003) were associated with increased odds of postoperative infection. Small hospital size was associated with decreased odds (odds ratio [OR], 0.5; P<0.001), whereas urban hospitals were associated with increased odds (OR, 2.14; P<0.14) of acquiring infection. Uninsured (OR, 1.62; P<0.0001) and patients with Medicaid (OR, 1.33; P<0.0001) were associated with higher odds of acquiring postoperative infection. C. difficile increased hospital length of stay by 8 days (P<0.0001), hospital charges by 2-fold (P<0.0001), and inpatient mortality to 4% from 0.11% (P<0.0001). C. difficile infection after lumbar spine surgery carries a 36.4-fold increase in mortality and costs approximately $10,658,646 per year to manage. These data suggest that great care should be taken to avoid C. difficile colitis in patients undergoing lumbar spine surgery because it is associated with longer hospital stays, greater overall costs, and increased inpatient mortality. 3.

Pseudomembraneous Negative Clostridium difficile Colitis in Patients with Inflammatory Bowel Disease Undergoing Colonoscopy: Retrospective Review

Pseudomembraneous Negative Clostridium difficile Colitis in Patients with Inflammatory Bowel Disease Undergoing Colonoscopy: Retrospective Review

Letter: Clostridium difficile colitis in patients with ulcerative colitis

Letter: <i>Clostridium difficile</i> colitis in patients with ulcerative colitis

Use of a neighboring uninjured nerve for restoration of tissue function

INTRODUCTION AND OBJECTIVES: Clostridium difficile (CD) colitis is at historically high levels, leading to increased complications and costs in patients undergoing major abdominal surgery involving the gastrointestinal tract. We sought to assess if screening and empiric treatment of preoperative asymptomatic CD carriers would decrease symptomatic CD colitis in patients undergoing cystectomy and urinary diversion METHODS: A prospective evaluation of CD carrier status was undertaken in patients undergoing cystectomy and urinary diversion between January-September 2015 by testing stool samples at the time of surgery. Patients identified as CD carriers were treated with intravenous metronidazole until return of bowel function. The incidence of clinically symptomatic CD colitis was assessed in this intention to treat cohort and compared to a retrospective cohort of 562 patients that underwent cystectomy during 2010-2013. RESULTS: A total of 78 patients were included in the intention to treat analysis, of which 62 (79%) were screened intraoperatively for CD. Of those screened, 18 (30%) were asymptomatic carriers of CD. The incidence of patients who developed symptomatic CD colitis in the intention to treat cohort was 3.8% (3/78 patients). Of those 3 patients, 2 were negative for CD preoperatively and 1 was unknown. None of the treated patients developed CD colitis or adverse outcomes. When compared to the historical cohort which had aCD colitis incidence of 8.8%, the relative risk reduction was 57% with a number needed to treat of 20. CONCLUSIONS: Cystectomy patients were found to have a high incidence of asymptomatic CD. Identification and treatment of asymptomatic carriers at time of surgery seems to decrease the incidence of CD colitis. Further studies are warranted to assess the utility and cost of testing for CD status followed with empiric treatment.

Risk factors for the development ofClostridium difficilecolitis in a surgical ward

PurposeClostridium difficile colitis (CDC) is a nosocomial infection. We attempted to discover the risk factors for the development of CDC in patients admitted to our surgical ward.MethodsWe conducted a retrospective chart review of all patients admitted to our surgical ward between January 2010 and July 2011. CDC was confirmed when toxin A/B or toxin B polymerase chain reaction was detected in the stool and clinical symptoms, such as diarrhea, were present. We divided patients into the CDC and non-CDC groups, and compared the clinical features between the two groups.ResultsThe rate of CDC occurrence was 0.4% (19/4,720 patients). Univariate analysis showed that colectomy (P < 0.001), hospital stays longer than 10 days (P < 0.001), aged over 55 years (P < 0.001) and transfer from medical ward (P = 0.009) were significant parameters for CDC. Multivariate analysis showed that colectomy (P < 0.001; odds ratio [OR], 8.405; 95% confidence interval [CI], 2.927 to 24.132) and hospital stays longer than 10 days (P = 0.035; OR, 10.253; 95% CI, 1.176 to 89.392) were high risk factors for CDC occurrence in the surgical ward.ConclusionThe risk factors for CDC in a surgical ward could be colectomy and a long duration of hospitalization. Therefore, clinicians should consider the possibility of CDC when patients undergo colectomy, are admitted for a long time, and have postoperative diarrhea.

Atypical presentation of Clostridium difficile colitis in patients with cystic fibrosis.

This report describes the unusual presentation of Clostridium difficile colitis in five patients with cystic fibrosis and the role of CT in first suggesting the correct diagnosis in this group of patients. Because of the absence of watery diarrhea and the presence of abdominal bloating and decreased stooling, cystic fibrosis patients with C. difficile colitis will be treated for stool impaction, meconium ileus equivalent, or distal intestinal obstruction syndrome. CT of the abdomen, performed in these five patients because of their lack of improvement after standard therapy for stool impaction, showed an extensive pancolitis later confirmed to be caused by C. difficile infection. In patients with cystic fibrosis, imaging findings of a pancolitis should raise the possibility of C. difficile colitis despite the lack of watery diarrhea. Anticlostridial treatment can be initiated before bacteriologic confirmation is obtained.

Clostridium difficile colitis associated with treatment of Helicobacter pylori infection

Helicobacter pylori infection of the stomach is being detected and treated more often now than ever before. This is likely to result in an increase in complications such as antibiotic-associated diarrhea. However, there is no literature on the incidence of such diarrhea, particularly Clostridium difficile colitis, in patients treated for Helicobacter pylori infection. We report the case of a patient who developed Clostridium difficile colitis after treatment for Helicobacter pylori infection with metronidazole, amoxicillin, H2 blockers, and bismuth subsalicylate. This patient presented with severe diarrhea that responded to a course of metronidazole with rapid disappearance of symptoms. The incidence of Clostridium difficile colitis in patients treated for Helicobacter pylori infection has not been studied. This unique association, although not unexpected, has not yet been reported in the literature. The increasing number of patients being diagnosed and treated for this infection requires a heightened awareness on the part of physicians, to assure early diagnosis and treatment of this treatable, yet potentially dangerous, complication.