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

Published online by Cambridge University Press:  02 January 2015

Amelia M. Kasper*
Affiliation:
Washington University School of Medicine, St. Louis, Missouri
Humaa A. Nyazee
Affiliation:
Washington University School of Medicine, St. Louis, Missouri
Deborah S. Yokoe
Affiliation:
Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
Jeanmarie Mayer
Affiliation:
University of Utah Hospital, Salt Lake City, Utah
Julie E. Mangino
Affiliation:
Ohio State University Medical Center, Columbus, Ohio
Yosef M. Khan
Affiliation:
Ohio State University Medical Center, Columbus, Ohio
Bala Hota
Affiliation:
Stroger Hospital of Cook County/Rush University Medical Center, Chicago, Illinois
Victoria J. Fraser
Affiliation:
Washington University School of Medicine, St. Louis, Missouri
Erik R. Dubberke
Affiliation:
Washington University School of Medicine, St. Louis, Missouri
*
Box 8051, 660 South Euclid, St. Louis, MO 63110 (edubberk@dom.wustl.edu)

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.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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References

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.Google Scholar
2.Dubberke, ER. Attributable outcomes of endemic Clostridium difficile-associated disease in nonsurgical patients. Emerg Infect Dis 2008;14:10311038.CrossRefGoogle ScholarPubMed
3.Dubberke, ER, Wertheimer, AI. Review of current literature on the economic burden of Clostridium difficile infection. Infect Control Hosp Epidemiol 2009;30:5766.Google Scholar
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.Google Scholar
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.Google Scholar
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.CrossRefGoogle ScholarPubMed
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.Google Scholar
8.Severe Clostridium difficile-associated disease in populations previously at low risk-four states, 2005. MMWR Morb Mortal Wkly Rep 2005;54:12011205.Google Scholar
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.CrossRefGoogle ScholarPubMed
10.Ali, SO, Welch, JP, Dring, RJ. Early surgical intervention for fulminant pseudomembranous colitis. Am Surg 2008;74:2026.CrossRefGoogle ScholarPubMed
11.Hall, JF, Berger, D. Outcome of colectomy for Clostridium difficile colitis: a plea for early surgical management. Am J Surg 2008; 196:384388.CrossRefGoogle ScholarPubMed
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.Google Scholar
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.CrossRefGoogle ScholarPubMed
14.Lipsett, PA, Samantaray, DK, Tam, ML, Bartlett, JG, Lillemoe, KD. Pseudomembranous colitis: a surgical disease? Surgery 1994;116: 491496.Google ScholarPubMed
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.Google Scholar
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.Google Scholar
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.CrossRefGoogle ScholarPubMed
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.Google Scholar
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.Google Scholar
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.CrossRefGoogle Scholar
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.CrossRefGoogle ScholarPubMed
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
26.Charlson, M, Szatrowski, TP, Peterson, J, Gold, J. Validation of a combined comorbidity index. J Clin Epidemiol 1994;47: 12451251.Google Scholar
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.Google Scholar