431. Abdominal CT Findings Predict Serious Complications from C difficile Infection
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Purpose: Identifying individuals with C difficile Infection (CDI) at risk for serious complications has become increasingly important. This is due to the rising frequency of infection and re-emergence of the BI/NAP1 strain. CT scans suggestive of severe CDI include one or more of the following: colon wall thickening ≥ 4mm with peri-colonic stranding, colon wall edema, the “accordion” sign, megacolon, or unexplained ascites. Our purpose was to determine if the presence of one or more of these radiographic findings is also predictive of a serious complication from CDI in a large study group.
Method: All patients admitted to Temple Hospital between 12/1/03 and 7/1/08 with a first case of CDI were eligible. From the EMR we extracted all clinical information including outcome data. Serious complications included the combined endpoint of emergent colon resection or death.
Results: Overall 80 of 200 (40%) indentified CDI patients underwent a CT scan within 48 hours of diagnosis. Fifty percent (n=40) showed severe CDI, the remainder were minimally abnormal or normal. There was no difference in age, sex, albumin, or BMI between the groups. Those with a severe CT had a remarkably higher WBC (25.2 ± 11.8 vs. 15.7± 7.7; P<0.001) and rise in % creatinine (76.7 ± 140.7 vs. 27.8 ± 42.9; P=0.04) from baseline during hospitalization. Overall 12/40 (30%) with a severe CT had a serious complication compared to 2/40 (5%) without (P=0.003). By logistic regression, severe findings per CT was associated with a CDI complication (OR=6.33, 95% CI 1.14-35.3; P=0.035) even after controlling for WBC and creatinine rise.
Conclusion: Severe findings per CT in the setting of CDI were strongly associated with a serious complication. Radiographic findings had predictive value independent of patient demographics, albumin, serum leukocytosis, and renal function. CT scanning provides an objective method to assess disease severity in CDI and we suggest a low threshold for ordering this study.
Frank Friendenberg, MD, MS (epi)1, Deepa Gujja, MD2, Sabba Maqbool, MD1 and  S. Maqbool, None. 
F. K. Friendenberg,
ViroPharma Role(s): Research Relationship, Received: Research Grant, Research Support.
D. Gujja, None., (1)Temple University School of Medicine, Philadelphia, PA, (2)Abington Memorial Hospital, Abington, PA