Clostridium difficile Infection and Colorectal Surgery: Is There Any Risk?

Abstract

Background and objectives: Clostridium difficile infection (CDI) is an important healthcare-associated infection, with important consequences both from a medical and financial point of view, but its correlation with anastomotic leaks after colorectal surgeries is scarcely reported in the literature. Materials and Methods: We conducted a retrospective study looking for patients who underwent open or laparoscopic surgery for colorectal cancers between January 2012 and December 2017, excluding emergency surgeries for complicated colorectal tumors. We also examined patient history for risk factors for CDI such as age, sex, comorbidities, and clinical findings at admission or during hospital stay as well as tumor characteristics. Results: A total of 360 patients were included in the study, out of which 320 underwent surgeries that included anastomoses. There were 19 cases of anastomotic leaks, out of which 13 patients were diagnosed with CDI, with a statistic significance for association between CDI and anastomotic leakage (p < 0.0001). Most patients who developed both CDI and anastomotic leaks had left-sided resections or a type of rectal resection, while none of the patients with right-sided resections had this association, but with no statistical significance possibly due to the limited number of cases. Conclusions: CDI is a relevant risk factor and should be taken into consideration when trying to prevent anastomotic leaks in patients undergoing gastrointestinal surgery for colon or rectal cancer. Thorough assessment of risk factors at admission should be mandatory in order to adequately prepare the patient and plan an optimal course of treatment. Further studies are needed to confirm our findings and a multidisciplinary approach, with a team which should always include the surgeon, is mandatory when it comes to CDI prevention.

Healthcare-associated Clostridioides difficile infection during the COVID-19 pandemic in a tertiary care hospital in Romania

“…Apart from antibiotic use, there are other factors associated with CDI, including higher age (>65 years), longer hospitalization, the use of proton pump inhibitors, comorbidities, chemotherapy, chronic kidney disease, abdominal surgery [5,6,7]. Use of broad-spectrum antimicrobial therapy was widely reported with over 70% of COVID-19 cases receiving antibacterial therapy despite current evidence which does not support a high rate of bacterial respiratory co-infections in patients with SARS-CoV-2 infection [8].…”

Ether-Based Polyurethane Foam for Vacuum-Assisted Closure (V.A.C.) of Complicated Postoperative Abdominal Wound Dehiscence

“…Further prospective studies are needed to solve the problem. Throughout their stay, we had four cases complicated with Clostridium difficile, which prolonged their admission, treated with Vancomycine [17]. In all four patients diagnosed with urinary tract infections, antibiotics therapy was instituted in accordance with their uroculture [18].…”

Clostridium difficile infection characteristics in a general surgery clinic

“…Although statistical associations can be made, the extent of the literature, the plausibility of these findings and the multiple drugs used in these patients alongside associate comorbidities make it difficult to have a strict causal relationship between all these risk factors and CDI (2,11). On the other hand, it seems that CDI is a relevant risk factor for anastomotic leaks in patients undergoing surgery for colon or rectal cancer (12). Comorbidities are another risk factor that may predispose individuals towards more serious CDI.…”