355. Patience is a Virtue: an Argument for Delayed Surgical intervention in Fulminant CDI
Session: Poster Abstract Session: Clostridium difficile - Epidemiology, Diagnosis, Treatment, and Prevention
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • Poster - Patience is a virtue - final.pdf (252.8 kB)
  • Background: Recently, the incidence and severity of Clostridium difficile infection (CDI) has increased.  In the US, CDI is the leading cause of mortality in patients with gastrointestinal disease.  In cases of fulminant CDI, surgery is a viable therapeutic option, but is associated with high mortality.  We evaluated factors associated with mortality in patients with severe CDI that required surgery from two large teaching hospitals.

    Methods: A retrospective study covering nearly 10 years was conducted in patients diagnosed with CDI by positive C. difficile toxin (CDT) and requiring colectomy.   Demographics, risk factors for CDI, comorbidities, clinical and lab data, medical and surgical management, and days between admission/diagnosis of CDI and colectomy were collected.  Conventional markers of severity, APACHE and ATLAS scores were validated as predictors of mortality.

     Results: A total of 64 patient cases were included.  The mean patient age was 70.9±12.3 yrs.  An average period of 3.5 ± 5.0 days between assay and surgery was noted.  The most common signs or symptoms were: Diarrhea, abdominal pain, and fever, none of which correlated with mortality.  Of the patients observed, 45.3% died within 30 days from surgery.  ATLAS scores were not correlated with mortality. However, risk factors correlated with post-surgical mortality were vasopressor use (positively, p=0.043) and time between a positive CDT assay and surgery (inversely, p=0.004). 

    Conclusion: The observed mortality rate of 45% is consistent with previously studied populations of patients undergoing surgery for CDI.  Clinical signs and symptoms of CDI and ATLAS scores did not correlate with mortality.  Vasopressor use was directly correlated with increased mortality, whereas time between CDT assay and surgery was inversely correlated with mortality.  This study represents one of the largest patient samples regarding CDI and mortality following colectomy in the US to date.  Consideration should be given to the importance of timing of colectomies in fulminant CDI.


    Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

    Jesse Clanton, MD1, Ryan Fawley2, Ken Koon Wong, MD3, Joel Porter4, Anurag Duggal, MD5, Charudutt Paranjape6, Nairmeen Haller, Ph.D5 and Hector Bonilla, MD7,8, (1)Surgery, Summa Health Systems, Akron , OH, (2)NEOUCOM, Rootstown, OH, (3)Medicine, Akron General Hospital, Akron, OH, (4)Surgery, Summa Health Systems, Akron, OH, (5)Akron General Medical Center, Akron, OH, (6)Akron General Hospital, Akron, OH, (7)Summa Health System, Akron, OH, (8)Northeastern Ohio Universities College of Medicine, Akron, OH

    Disclosures:

    J. Clanton, None

    R. Fawley, None

    K. K. Wong, None

    J. Porter, None

    A. Duggal, None

    C. Paranjape, None

    N. Haller, None

    H. Bonilla, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.