title: Clostridium difficile of the ileum following total abdominal colectomy, with or without proctectomy:  who is at risk?
abstract: BACKGROUND
  Clostridium difficile enteritis is considered a rare entity, although recent data suggest a significant increase in prevalence and incidence. There is paucity of data evaluating risk factors of C difficile enteritis following total colectomy.
  
  
  OBJECTIVE
  The aim of this study was to determine the incidence and risk factors of C difficile enteritis for patients who had undergone total abdominal colectomy with or without proctectomy.
  
  
  METHODS
  This study involves a retrospective chart review of 310 patients. Univariate analysis was performed on potential risk factors (p ≤ 0.05) with the use of a logistic regression model, and a Fisher exact test was used for variables that had no occurrences of C difficile. These groups of variables were then examined in a multiple variate setting with stepwise logistic regression analysis.
  
  
  METHODS
  This study was conducted at a tertiary referral center.
  
  
  METHODS
  A data analysis was performed on patients who had undergone total abdominal colectomy with or without proctectomy who were tested for C difficile of the ileum.
  
  
  RESULTS
  Twenty-two of 137 patients that were tested (16%) were positive for C difficile of the ileum. Univariate analysis of known risk factors for C difficile demonstrated that black race was a protective factor against C difficile (p = 0.016). The multivariate analysis demonstrated that emergency surgery (p = 0.035), race (p = 0.003), and increasing age by decade (p = 0.033) were risk factors for C difficile.
  
  
  CONCLUSIONS
  This study was limited by the small patient sample, and it was not a randomized trial.
  
  
  CONCLUSIONS
  Black race is protective, and whites are 4 times more likely to acquire C difficile of the ileum after undergoing a total abdominal colectomy with or without proctectomy. The data also demonstrated that an increased age by a decade and emergency surgery are risk factors for C difficile enteritis, whereas the described risk factors of C difficile of the colon and type of colon surgery do not appear to influence the risk of C difficile of the ileum.
authors.affiliation: Department of General Surgery, Henry Ford Hospital, Detroit, MI, USA. athtsiouris@hotmail.com
authors.forename: Athanasios
authors.initials: A
authors.lastname: Tsiouris
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Neale
authors.forename: Craig A
authors.initials: CA
authors.lastname: Reickert
authors.forename: Melissa
authors.initials: M
authors.lastname: Times
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016360:Clostridioides difficile; D003082:Colectomy; D003092:Colitis / Q000601:surgery*; D003110:Colonic Neoplasms / Q000601:surgery*; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000208:ethnology / Q000382:microbiology; D005260:Female; D006801:Humans; D007077:Ileal Diseases / Q000453:epidemiology* / Q000208:ethnology / Q000382:microbiology; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors