title: Postoperative Clostridium difficile-associated diarrhea.
abstract: BACKGROUND
  Abdominal surgery is thought to be a risk factor for Clostridium difficile-associated diarrhea (CDAD). The aims of this study were to discern pre-operative factors associated with postoperative CDAD, examine outcomes after postoperative CDAD, and compare outcomes of postoperative versus medical CDAD.
  
  
  METHODS
  Data from 3904 patients who had abdominal operations at Montefiore Medical Center were extracted from Montefiore's clinical information system. Cases of 30-day postoperative CDAD were identified. Pre-operative factors associated with developing postoperative CDAD were identified using logistic regression. Medical patients and surgical patients with postoperative CDAD were compared for demographic and clinical characteristics, CDAD recurrence, and 90-day postinfection mortality.
  
  
  RESULTS
  The rate of 30-day postoperative CDAD was 1.2%. After adjustment for age and comorbidities, factors significantly associated with postoperative CDAD were: antibiotic use (OR: 1.94), proton pump inhibitor (PPI) use (OR: 2.32), prior hospitalization (OR: 2.27), and low serum albumin (OR: 2.05). In comparison with medical patients with CDAD, postoperative patients with CDAD were significantly more likely to have received antibiotics (98% vs 85%), less likely to have received a PPI (39% vs 58%), or to have had a prior hospitalization (43% vs 67%). Postoperative patients with CDAD had decreased risk of mortality when compared with medical patients with CDAD (HR 0.36).
  
  
  CONCLUSIONS
  CDAD is an infrequent complication after abdominal operations. Several avoidable pre-operative exposures (eg, antibiotic and PPI use) were identified that increase the risk of postoperative CDAD. Postoperative CDAD is associated with decreased risk of mortality when compared with CDAD on the medical service.
authors.affiliation: Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA. wsouther@montefiore.org
authors.forename: William N
authors.initials: WN
authors.lastname: Southern
authors.forename: Rabin
authors.initials: R
authors.lastname: Rahmani
authors.forename: Olga
authors.initials: O
authors.lastname: Aroniadis
authors.forename: Igal
authors.initials: I
authors.lastname: Khorshidi
authors.forename: Andy
authors.initials: A
authors.lastname: Thanjan
authors.forename: Christopher
authors.initials: C
authors.lastname: Ibrahim
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Brandt
mesh_terms: D000005:Abdomen / Q000601:surgery; D000328:Adult; D000368:Aged; D016360:Clostridioides difficile / Q000472:pathogenicity*; D003967:Diarrhea / Q000209:etiology* / Q000401:mortality; D004761:Enterocolitis, Pseudomembranous / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D012307:Risk Factors