title: Early colectomy may be associated with improved survival in fulminant Clostridium difficile colitis: an 8-year experience.
abstract: BACKGROUND
  We hypothesized that colectomy for fulminant Clostridium difficile colitis (CDC) before organ failure would be associated with decreased mortality.
  
  
  METHODS
  Data were retrospectively collected on patients operated on for CDC between 2000 and 2007. Variables examined included age, sex, immunodeficiency, recurrent CDC, vasopressor requirement, acute respiratory failure, acute renal failure, white blood cell count, and stress ulcer prophylaxis. Univariate and multivariate analyses were performed to identify predictors of mortality.
  
  
  RESULTS
  During this period, 6,841 patients were diagnosed with CDC and 69 patients underwent surgery. Independent predictors of mortality were age >65 years (odds ratio [OR] 6.8, confidence interval [CI] 1.4-32.3, P = .016), acute respiratory failure (OR 5.4, CI 1.6-18.1, P = .007), and acute renal failure (OR 3.8, CI 1.1-13.1, P = .035).
  
  
  CONCLUSIONS
  Colectomy before the development of organ failure is associated with decreased mortality in patients with fulminant CDC, especially in those >65 years old.
authors.affiliation: Department of Surgery, Division of Infectious Diseases, William Beaumont Hospitals, Royal Oak, MI 48073, USA.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Seder
authors.forename: Mario R
authors.initials: MR
authors.lastname: Villalba
authors.forename: James
authors.initials: J
authors.lastname: Robbins
authors.forename: Felicia A
authors.initials: FA
authors.lastname: Ivascu
authors.forename: Christopher F
authors.initials: CF
authors.lastname: Carpenter
authors.forename: Mary
authors.initials: M
authors.lastname: Dietrich
authors.forename: Mario R
authors.initials: MR
authors.lastname: Villalba
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000150:complications*; D004761:Enterocolitis, Pseudomembranous / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000382:microbiology / Q000517:prevention & control; D012189:Retrospective Studies