title: Diarrhea and Clostridium difficile-associated diarrhea on a surgical service.
abstract: OBJECTIVE
  To identify the incidence, risk factors, and treatment of diarrhea and Clostridium difficile-associated diarrhea (CDAD) in surgery patients.
  
  
  METHODS
  Prospective and historical retrospective analysis.
  
  
  METHODS
  Major urban tertiary care referral hospital.
  
  
  METHODS
  Consecutive patients (N = 475) admitted to the vascular, trauma, and general surgical surgery services, prospectively evaluated during a 10-week period. A retrospective historical control of the same surgical services was used for comparison.
  
  
  METHODS
  None.
  
  
  METHODS
  Incidence of diarrhea and CDAD, use of bowel preparations, surgical procedure, use of C difficile toxin assay, white blood cell count, symptoms, treatment, and delay in hospital discharge.
  
  
  RESULTS
  The incidence of diarrhea in surgery patients analyzed prospectively was 6.1%; the incidence of CDAD during the prospective and retrospective periods was 2%. Preoperative bowel preparations were associated with an increased risk of diarrhea (relative risk, 4.2; 95% confidence interval, 2.6-6.8; P < .001) and CDAD (relative risk, 3.2; 95% confidence interval, 1.5-7.2; P < .03). Leukocytosis (white blood cell count > 11 x 10(9)/L) was significantly higher in the CDAD group compared with the diarrhea group only on the day of diagnosis (P < .05). By subjective analysis, diarrhea was directly responsible for a delay in discharge in 7 of 29 patients for a mean (+/-SEM) of 4.0 +/- 1.0 days.
  
  
  CONCLUSIONS
  Patients undergoing preoperative bowel preparations are at increased risk of experiencing diarrhea and CDAD. Among patients with diarrhea, an elevated white blood cell count may help identify those with C difficile. Early treatment of diarrhea with oral metronidazole while awaiting the results of the stool toxin assay is recommended for treating diarrhea in surgery patients. Prophylactic treatment of surgery patients undergoing bowel preparations should be considered.
authors.affiliation: Department of Surgery, New York Hospital-Cornell University Medical Center, New York, USA.
authors.forename: M D
authors.initials: MD
authors.lastname: McCarter
authors.forename: C
authors.initials: C
authors.lastname: Abularrage
authors.forename: F T
authors.initials: FT
authors.lastname: Velasco
authors.forename: J M
authors.initials: JM
authors.lastname: Davis
authors.forename: J M
authors.initials: JM
authors.lastname: Daly
mesh_terms: D000368:Aged; D016360:Clostridioides difficile; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000382:microbiology*; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors