Development Of Clostridium Difficile Colitis Research Articles

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.

Acute Perforating Diverticulitis Associated with Active Ulcerative Colitis: Yes, It Does Occur

A 79-year-old female with a past medical history of UC presented with persistent watery diarrhea, abdominal pain, nausea, vomiting, and low-grade fever. She had originally presented 1.5 years prior with persistent hematochezia prompting colonoscopy which revealed congestion, erosions, erythema, friability, granularity and loss of vascularity extending in a continuous and circumferential pattern from the anus to the sigmoid colon. Numerous small and large-mouthed diverticula were found in the sigmoid colon and in the descending colon. Rectosigmoid biopsy revealed crypt distortion with increased lymphoplasmacytic and neutrophilic inflammatory infiltrate in the lamina propria and associated cryptitis, crypt abscesses, and reactive epithelial cell changes consistent with a diagnosis of UC. Over the next 1.5 years she intermittently tolerated combinations of 5-aminosalicylic acid preparations (5-ASA) and steroid suppositories and enemas with concomitant oral 5-ASA therapies. However she eventually developed steroid-dependent UC. Given persistent side effects of chronic steroid therapy biologic therapy with infliximab was started approximately one week prior to presentation. On admission to hospital, she was started on broad-spectrum antibiotics and intravenous steroids. With a negative infectious workup, she was continued on an accelerated infliximab program. This was complicated by the development of Clostridium Difficile colitis, requiring oral vancomycin therapy. She subsequently developed worsening abdominal pain prompting computed-tomography evaluation which revealed colitis with increased wall thickening and pericolonic inflammation along the descending colon with an associated droplet of extraluminal air and rim-enhancing fluid in the left paracolic gutter compatible with perforation. She underwent emergent exploratory laparotomy with identification of a descending colonic perforation resulting in subtotal colectomy with end ileostomy. Her post-op course was complicated by multiple pelvic fluid collections documented on serial imaging requiring drainage and growth of Vancomycin-Resistant Enteroccocus. Microscopic surgical pathology showed chronic UC associated with extensive colonic diverticulosis with acute perforative diverticulitis, subserosal abscesses and acute purulent serositis. The inflammation of UC was limited to the deep submucosa. There was no dysplasia, granulomata, or viral inclusions present.

Proton Pump Inhibitor Therapy Increases the Expression of Toxin Genes in Clostridium Difficile in a Ribotype Dependent Manner

The use of proton pump inhibitors (PPI) has recently been associated with the development of Clostridium difficile colitis (CDC). However, the mechanism by which PPI's effect the behavior of C. difficile have remained largely uninvestigated. The purpose of the present study was to investigate whether PPI's exerted any effect on the expression of C. difficile toxin genes.

Potentially inappropriate treatment of urinary tract infections in two Rhode Island nursing homes.

The aim of this study was to determine the appropriateness of antibiotic initiation, selection, and duration of therapy among patients in nursing homes with results of a urinalysis showing urinary tract infection. A retrospective chart review was conducted on patients of 2 nursing homes during a 6-month period (June 1-November 30, 2008). If a urinalysis had been ordered, the case was evaluated for the appropriateness of antibiotic initiation based on the McGeer criteria. For patients receiving antibiotics, the appropriateness of the initial selection, dosing schedule, and duration of treatment were assessed using patient-specific information and Infectious Diseases Society of American criteria. Patients' records were also reviewed for information on the development of Clostridium difficile colitis. A total of 519 records were reviewed for documentation of a urinalysis; 132 patients, with a total of 172 case patients (ie, urinalysis showing infection) met inclusion criteria. Antibiotic treatment was initiated in 96 of the 172 case patients (56%); 146 case patients (85%) did not meet the McGeer criteria, yet antibiotic treatment was initiated in 70 of these (41%). Furthermore, 69 case patients (72%) received an inappropriate drug based on Infectious Diseases Society of American criteria, 44 case patients (46%) received inappropriate drug dosing based on creatinine clearance, and 64 case patients (67%) received treatment for longer than recommended. Patients who did not meet the McGeer criteria but received antibiotic therapy were 8.5 (95% confidence interval, 1.7-42.2) times more likely to develop C difficile within 3 months of treatment. Opportunities exist to improve provider practice related to the appropriate treatment of urinary tract infections in the nursing home.