title: The surgical management of active ulcerative colitis complicated by Clostridium difficile infection.
abstract: BACKGROUND
  Clostridium difficile stool toxin is detected in 5-20 % of patients with acute exacerbations of ulcerative colitis (UC). There is little data regarding the safety of surgery for UC with concurrent C. difficile.
  
  
  METHODS
  A retrospective review was performed of 23 patients undergoing colectomy for refractory UC complicated by C. difficile infection between January 2002 and June 2012. Patients were stratified into those who completed a full antibiotic course for C. difficile infection prior to surgery (group A, n = 7) and those who proceeded directly to surgery (group B, n = 16). The primary endpoints of perioperative mortality, ICU requirement, reoperation, readmission, and surgical site infection were assessed within 30 days after surgery.
  
  
  RESULTS
  Postoperatively, no mortalities, ICU admissions, readmission, or reoperations occurred. One group A patient developed a superficial wound infection, which resolved with a course of outpatient antibiotics (14 vs. 0 %, p = 0.12). Average days until return of bowel function and average length of postoperative stay were comparable between group A and B (3.9 vs. 3.6 days, p = 0.70; 7.0 vs. 6.9 days, p = 0.87; respectively). Ninety-one percent of patients subsequently underwent ileal pouch-anal anastomosis.
  
  
  CONCLUSIONS
  Colectomy for ulcerative colitis complicated by C. difficile can be performed safely without completing a course of antibiotic therapy.
authors.affiliation: Department of Surgery, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1259, New York, NY 10029, USA.
authors.forename: Edward W
authors.initials: EW
authors.lastname: Chu
authors.forename: Brett L
authors.initials: BL
authors.lastname: Ecker
authors.forename: Malika
authors.initials: M
authors.lastname: Garg
authors.forename: Celia M
authors.initials: CM
authors.lastname: Divino
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000150:complications*; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000150:complications* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult