Infection Control & Hospital Epidemiology

Original Articles

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

Amelia M. Kaspera1 c1, Humaa A. Nyazeea1, Deborah S. Yokoea2, Jeanmarie Mayera3, Julie E. Manginoa4, Yosef M. Khana4, Bala Hotaa5, Victoria J. Frasera1, Erik R. Dubberkea1 and Centers for Disease Control and Prevention Epicenters Program

a1 Washington University School of Medicine, St. Louis, Missouri

a2 Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts

a3 University of Utah Hospital, Salt Lake City, Utah

a4 Ohio State University Medical Center, Columbus, Ohio

a5 Stroger Hospital of Cook County/Rush University Medical Center, Chicago, Illinois

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.

(Received September 27 2011)

(Accepted December 15 2011)

Correspondence

c1 Box 8051, 660 South Euclid, St. Louis, MO 63110 (edubberk@dom.wustl.edu)