The morbidity of Clostridium difficile infection after elective colonic resection-results from a national population database.
BACKGROUND
Clostridium difficile (CD), a gram-positive rod bacterium, resides normally within the human colon. Antibiotic treatment alters normal colonic flora, potentiating abnormal overgrowth of CD.


METHODS
This study examined the 2004 to 2006 Nationwide Inpatient Sample to determine outcomes of CD colitis after 695,010 elective colonic resections.


RESULTS
CD infection, occurring in 1.4% of patients, was associated with higher pulmonary (12.1% vs 6.4%) and gastrointestinal (12.8% vs 10.5%) complications as well as an increased length of stay (22.6 vs 10.9 days) and mortality (16.2% vs 4.9%; all P < .001). CD colitis patients more frequently held Medicare insurance (68% vs 51%) and underwent small segmental colonic resection as opposed to a defined anatomic resection (20.0% vs 9.9%; P < .001). An underlying diagnosis of colon cancer was associated with a lower incidence of CD colitis (odds ratio, .71; 95% confidence interval, .59-.84; P < .001).


CONCLUSIONS
CD colitis is associated with worse outcomes after elective colonic resection.
Department of Surgery, Madigan Army Medical Center, Tacoma, WA 98433, USA.
Kelly
K
Lesperance
Marlin Wayne
MW
Causey
Michael
M
Spencer
Scott Russell
SR
Steele
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000453:epidemiology* / Q000209:etiology* / Q000382:microbiology; D003082:Colectomy / Q000009:adverse effects* / Q000379:methods; D003092:Colitis / Q000453:epidemiology* / Q000209:etiology* / Q000382:microbiology; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D016208:Databases, Factual; D004761:Enterocolitis, Pseudomembranous / Q000209:etiology; D005260:Female; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007348:Insurance, Health; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010351:Patient Discharge; D015995:Prevalence; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology; D055815:Young Adult