title: Clostridium difficile infection in patients with ileal pouch-anal anastomosis.
abstract: OBJECTIVE
  There has been an increase in the incidence and severity of Clostridium difficile-associated diarrhea in the U.S. The importance of C difficile infection in patients with ileal pouch-anal anastomosis (IPAA) is unknown. This study was designed to determine risk of acquiring C difficile infection in pouch disorders.
  
  
  METHODS
  Consecutive ulcerative colitis patients (n = 115) with IPAA undergoing pouch endoscopy were enrolled from May 2005-March 2006. Fecal specimens of pouch aspirate were collected during pouch endoscopy and analyzed for C difficile toxin A and B by enzyme-linked immunosorbent assay. Nineteen clinical, endoscopic, and histologic variables were assessed with stepwise selection methods. Two multivariate logistic regression models were constructed.
  
  
  RESULTS
  Twenty-one patients (18.3%) were positive for C difficile infection. Adjusting for other factors in the model, men were 5.12 (95% confidence interval, 1.38-20.46) times more likely to have C difficile infection than women. Compared with patients with pancolitis, those with preoperative left-sided colitis were 8.4 (95% confidence interval, 1.25-56.4) times more likely to have C difficile infection. Six of 6 patients with C difficile infection (3 with refractory pouchitis, 2 with Crohn's disease, and 1 with irritable pouch syndrome) with repeat clinical, endoscopic, and laboratory evaluation after anti-C difficile therapy experienced clinical remission and disappearance of C difficile toxin from stools, with 4 showing decreased mucosal inflammation.
  
  
  CONCLUSIONS
  C difficile infection involving IPAA is common, characteristically occurring with or without previous receipt of antibiotics. Treatment of C difficile infection in patients with IPAA might improve the clinical outcome.
authors.affiliation: Center for Inflammatory Bowel Disease, Department of Gastroenterology/Hepatology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: B O
authors.initials: BO
authors.lastname: Shen
authors.forename: Zhi-Dong
authors.initials: ZD
authors.lastname: Jiang
authors.forename: Victor W
authors.initials: VW
authors.lastname: Fazio
authors.forename: Feza H
authors.initials: FH
authors.lastname: Remzi
authors.forename: Liliana
authors.initials: L
authors.lastname: Rodriguez
authors.forename: Ana E
authors.initials: AE
authors.lastname: Bennett
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.forename: Elaine
authors.initials: E
authors.lastname: Queener
authors.forename: Herbert L
authors.initials: HL
authors.lastname: Dupont
mesh_terms: D000328:Adult; D001003:Anal Canal; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D001426:Bacterial Proteins / Q000032:analysis; D001427:Bacterial Toxins / Q000032:analysis; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003093:Colitis, Ulcerative / Q000150:complications* / Q000601:surgery*; D039021:Colonic Pouches; D003967:Diarrhea / Q000382:microbiology; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis / Q000453:epidemiology*; D004768:Enterotoxins / Q000032:analysis; D004797:Enzyme-Linked Immunosorbent Assay; D005243:Feces / Q000737:chemistry; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors; D014481:United States
chemical_list: D001426:Bacterial Proteins; D001427:Bacterial Toxins; D004768:Enterotoxins; C041348:tcdA protein, Clostridium difficile; C031815:toxB protein, Clostridium difficile