Methods: A retrospective case-matched control study was conducted to explore the clinical features of CDE. All patients status-post total colectomy at the University of Michigan Health System between 1/1993-2/2013 were identified. CDE cases were defined by the presence of symptoms (diarrhea, increased stool output, abdominal pain, or ileus) and positive testing for C. difficile following colectomy. Post colectomy patients without positive C. difficile testing served as controls. Data on demographics, surgical variables, medication use (antibiotics, parenteral nutrition, acid-suppressive agents), symptoms, timing of infection, disease recurrence, and mortality were collected. Initial descriptive statistics were calculated including frequencies and measures of central tendency/spread. Logistic regression or Cox proportional hazards models were utilized to evaluate whether putative risk factors associated with initial CDE and with recurrence.
Results: A total of 944 patients underwent total colectomy and 55 (5.8%) tested positive for C. difficile. However, only 44 (4.7%) met CDE criteria. The median age in CDE was 47 compared to 45 for controls (P =.527), with 25 (56.8%) females compared to 427 (47.4%) in controls (P =.289). The median time between colectomy and CDE was 129.5 days (IQR 671.5), with 45.4% occurring in the first 90 days. Significantly increased stool output was the most common symptom and cases usually required admission. Age and gender were not associated with CDE overall, but age was associated with onset in the first 90 days (OR 1.06, 95% CI 1.02-1.11, P =.005). Recurrent CDE occurred in 22.7% of cases and was not associated with gender or age.
Conclusion: CDE following total colectomy is a rare clinical entity, often resulting in severe symptoms requiring inpatient admission. Age predicts earlier onset and recurrent disease is common.
H. Imlay, None
K. Lopez, None
S. Cinti, None
K. Rao, None