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A Multicenter Study of Clostridium difficile Infection—Related Colectomy, 2000—2006

  • Amelia M. Kasper (a1), Humaa A. Nyazee (a1), Deborah S. Yokoe (a2), Jeanmarie Mayer (a3), Julie E. Mangino (a4), Yosef M. Khan (a4), Bala Hota (a5), Victoria J. Fraser (a1), Erik R. Dubberke (a1) and Centers for Disease Control and Prevention Epicenters Program...

Abstract

Objective.

To assess Clostridium difficile infection (CDI)-related colectomy rates by CDI surveillance definitions and over time at multiple healthcare facilities.

Setting.

Five university-affiliated acute care hospitals in the United States.

Design and Methods.

Cases of CDI and patients who underwent colectomy from July 2000 through June 2006 were identified from 5 US tertiary care centers. Monthly CDI-related colectomy rates were calculated as the number of CDI-related colectomies per 1,000 CDI cases, and cases were categorized according to recommended surveillance definitions. Logistic regression was performed to evaluate risk factors for CDI-related colectomy.

Results.

In total, 8,569 cases of CDI were identified, and 75 patients underwent CDI-related colectomy. The overall colectomy rate was 8.7 per 1,000 CDI cases. The CDI-related colectomy rate ranged from 0 to 23 per 1,000 CDI episodes across hospitals. The colectomy rate for healthcare-facility-onset CDI was 4.3 per 1,000 CDI cases, and that for community-onset CDI was 16.5 per 1,000 CDI cases (P < .05). There were significantly more CDI-related colectomies at hospitals B and C (P < .05).

Conclusions.

The overall CDI-related colectomy rate was low, and there was no significant change in the CDI-related colectomy rate over time. Onset of disease outside the study hospital was an independent risk factor for colectomy.

Copyright

Corresponding author

Box 8051, 660 South Euclid, St. Louis, MO 63110 (edubberk@dom.wustl.edu)

References

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1.Dallal, RM, Harbrecht, BG, Boujoukas, AJ, et al. Fulminant Clostridium difficile: an underappreciated and increasing cause of death and complications. Ann Surg 2002;235:363672.
2.Dubberke, ER. Attributable outcomes of endemic Clostridium difficile-associated disease in nonsurgical patients. Emerg Infect Dis 2008;14:10311038.
3.Dubberke, ER, Wertheimer, AI. Review of current literature on the economic burden of Clostridium difficile infection. Infect Control Hosp Epidemiol 2009;30:5766.
4.Dubberke, ER, Butler, AM, Yokoe, DS, et al. Multicenter study of Clostridium difficile infection rates from 2000 to 2006. Infect Control Hosp Epidemiol 2010;31:10301037.
5.McDonald, LC, Killgore, GE, Thompson, A, et al. An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med 2005;353:24332441.
6.Pépin, J, Valiquette, L, Cossette, B. Mortality attributable to nosocomial Clostridium difficile-associated disease during an epidemic caused by a hypervirulent strain in Quebec. CMAJ 2005; 173:10371042.
7.Warny, M, Pepin, J, Fang, A, et al. Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe. Lancet 2005;366: 10791084.
8.Severe Clostridium difficile-associated disease in populations previously at low risk-four states, 2005. MMWR Morb Mortal Wkly Rep 2005;54:12011205.
9.Kutty, PK, Woods, CW, Sena, AC, et al. Risk factors for and estimated incidence of community-associated Clostridium difficile infection, North Carolina, USA. Emerg Infect Dis 2010;16: 197204.
10.Ali, SO, Welch, JP, Dring, RJ. Early surgical intervention for fulminant pseudomembranous colitis. Am Surg 2008;74:2026.
11.Hall, JF, Berger, D. Outcome of colectomy for Clostridium difficile colitis: a plea for early surgical management. Am J Surg 2008; 196:384388.
12.Koss, K, Clark, MA, Sanders, DS, Morton, D, Keighley, MR, Goh, J. The outcome of surgery in fulminant Clostridium difficile colitis. Colorectal Dis 2006;8:149154.
13.Lamontagne, F, Labbé, A-C, Haeck, O, et al. Impact of emergency colectomy on survival of patients with fulminant Clostridium difficile colitis during an epidemic caused by a hypervirulent strain. Ann Surg 2007;245:267272.
14.Lipsett, PA, Samantaray, DK, Tam, ML, Bartlett, JG, Lillemoe, KD. Pseudomembranous colitis: a surgical disease? Surgery 1994;116: 491496.
15.Seder, CW, Villalba, MR, Robbins, J, et al. Early colectomy may be associated with improved survival in fulminant Clostridium diffidle colitis: an 8-year experience. Am J Surg 2009;197:302307.
16.Byrn, JC, Maun, DC, Gingold, DS, Baril, DT, Ozao, JJ, Divino, CM. Predictors of mortality after colectomy for fulminant Clostridium difficile colitis. Arch Surg 2008;143:150154.
17.Synnott, K, Mealy, K, Merry, L, Kyne, L, Keane, C, Quill, R. Timing of surgery for fulminating pseudomembranous colitis. Br J Surg 1998;85:229231.
18.Sailhamer, EA, Carson, K, Chang, Y, et al. Fulminant Clostridium difficile colitis: patterns of care and predictors of mortality. Arch Surg 2009; 144:433439.
19.Loo, VG, Poirier, L, Miller, MA, et al. A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med 2005; 353:24422449.
20.Miller, M, Gravel, D, Mulvey, M, et al. Health care-associated Clostiridium difficile infection in Canada: patient age and infecting strain type are highly predictive of severe outcome and mortality. Clin Infect Dis 2010;50:194201.
21.Ricciardi, R, Rothenberger, DA, Madoff, RD, Baxter, NN. Increasing prevalence and severity of Clostridium difficile colitis in hospitalized patients in the United States. Arch Surg 2007;142:624631.
22.Dubberke, ER, Butler, AM, Yokoe, DS, et al. Multicenter study of surveillance for hospital-onset Clostridium difficile infection by the use of ICD-9-CM diagnosis codes. Infect Control Hosp Epidemiol 2010;31:262268.
23.Dubberke, ER, Butler, AM, Hota, B, et al. Multicenter study of the impact of community-onset Clostridium difficile infection on surveillance for C. difficile infection. Infect Control Hosp Epidemiol 2009;30:518525.
24.Kutty, PK, Benoit, SR, Woods, CW, et al. Assessment of Clostridium difficile-associated disease surveillance definitions, North Carolina, 2005. Infect Control Hosp Epidemiol 2008;29:197202.
25.McDonald, LC, Coignard, B, Dubberke, E, Song, X, Horan, T, Kutty, PK. Recommendations for surveillance of Clostridium difficile-associated disease. Infect Control Hosp Epidemiol 2007;28: 140145.
26.Charlson, M, Szatrowski, TP, Peterson, J, Gold, J. Validation of a combined comorbidity index. J Clin Epidemiol 1994;47: 12451251.
27.Zilberberg, MD, Shorr, AF, Micek, ST, Doherty, JA, Kollef, MH. Clostridium difficile-associated disease and mortality among the elderly critically ill. Crit Care Med 2009;37:25832589.

A Multicenter Study of Clostridium difficile Infection—Related Colectomy, 2000—2006

  • Amelia M. Kasper (a1), Humaa A. Nyazee (a1), Deborah S. Yokoe (a2), Jeanmarie Mayer (a3), Julie E. Mangino (a4), Yosef M. Khan (a4), Bala Hota (a5), Victoria J. Fraser (a1), Erik R. Dubberke (a1) and Centers for Disease Control and Prevention Epicenters Program...

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