title: Clostridium difficile infection worsens the prognosis of ulcerative colitis.
abstract: BACKGROUND
  The impact of Clostridium difficile infections among ulcerative colitis (UC) patients is well characterized. However, there is little knowledge regarding the association between C difficile infections and postoperative complications among UC patients.
  
  
  OBJECTIVE
  To determine whether C difficile infection is associated with undergoing an emergent colectomy and experiencing postoperative complications.
  
  
  METHODS
  The present population-based case-control study identified UC patients admitted to Calgary Health Zone hospitals for a flare between 2000 and 2009. C difficile toxin tests ordered in hospital or 90 days before hospital admission were provided by Calgary Laboratory Services (Calgary, Alberta). Hospital records were reviewed to confirm diagnoses and to extract clinical data. Multivariate logistic regression analyses were performed among individuals tested for C difficile to examine the association between C difficile infection and emergent colectomy and diagnosis of any postoperative complications and, secondarily, an infectious postoperative complication. Estimates were presented as adjusted ORs with 95% CIs.
  
  
  RESULTS
  C difficile was tested in 278 (58%) UC patients and 6.1% were positive. C difficile infection was associated with an increased risk for emergent colectomy (adjusted OR 3.39 [95% CI 1.02 to 11.23]). Additionally, a preoperative diagnosis of C difficile was significantly associated with the development of postoperative infectious complications (OR 4.76 [95% CI 1.10 to 20.63]).
  
  
  CONCLUSIONS
  C difficile diagnosis worsened the prognosis of UC by increasing the risk of colectomy and postoperative infectious complications following colectomy. Future studies are needed to explore whether early detection and aggressive management of C difficile infection will improve UC outcomes.
authors.forename: María E
authors.initials: ME
authors.lastname: Negrón
authors.forename: Herman W
authors.initials: HW
authors.lastname: Barkema
authors.forename: Kevin
authors.initials: K
authors.lastname: Rioux
authors.forename: Jeroen
authors.initials: J
authors.lastname: De Buck
authors.forename: Sylvia
authors.initials: S
authors.lastname: Checkley
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Proulx
authors.forename: Alexandra
authors.initials: A
authors.lastname: Frolkis
authors.forename: Paul L
authors.initials: PL
authors.lastname: Beck
authors.forename: Levinus A
authors.initials: LA
authors.lastname: Dieleman
authors.forename: Remo
authors.initials: R
authors.lastname: Panaccione
authors.forename: Subrata
authors.initials: S
authors.lastname: Ghosh
authors.forename: Gilaad G
authors.initials: GG
authors.lastname: Kaplan
mesh_terms: D000328:Adult; D000368:Aged; D000416:Alberta / Q000453:epidemiology; D016022:Case-Control Studies; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003082:Colectomy / Q000706:statistics & numerical data; D003093:Colitis, Ulcerative / Q000601:surgery*; D018450:Disease Progression; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000382:microbiology; D012044:Regression Analysis