Clostridium Difficile of the Ileum Following Total Abdominal Colectomy, With or Without Proctectomy

Tsiouris, Athanasios; Neale, Jeffrey A.; Reickert, Craig A.; Times, Melissa

doi:10.1097/dcr.0b013e31823f86a2

Cited by 20 publications

(8 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Recognized CDI risk factors include advanced age, exposure to antibiotics, health care environment exposure, and possibly gastric acid suppression (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). Although previous studies suggested racial differences in CDI risks and mortality rates (14)(15)(16), the current literature does not identify race as a risk factor for CDI. This study utilized discharge data from the Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality (www.hcup-us.ahrq.gov/nisoverview.jsp), to evaluate whether CDI rates vary with race, to explore confounders of the relationship between race and CDI rates, and to investigate whether racial disparities in CDI rates persist when confounders are minimized.…”

contrasting

confidence: 46%

Racial Differences in Clostridium difficile Infection Rates Are Attributable to Disparities in Health Care Access

Mao

Kelly

Machan

2015

Antimicrob Agents Chemother

View full text Add to dashboard Cite

dThis study confirms previously reported racial differences in Clostridium difficile infection (CDI) rates in the United States and explores the nature of those differences. We conducted a retrospective study using the 2010 Nationwide Inpatient Sample, the largest all-payer database of hospital discharges in the United States. We identified hospital stays most likely to include antibiotic treatment for infections, based on hospital discharge diagnoses, and we examined how CDI rates varied, in an attempt to distinguish between genotypic and environmental racial differences. Logistic regressions for the survey design were used to test hypotheses. Among patients likely to have received antibiotics, white patients had higher CDI rates than black, Hispanic, Asian, and Native American patients (P < 0.0001). CDI rates increased with higher income levels and were higher for hospitalizations paid by private insurance versus those paid by Medicaid or classified as self-pay or free care (P < 0.0001). Among patients admitted from skilled nursing facilities, where racial bias in health care access is less, racial differences in CDI rates disappeared (P ‫؍‬ 1.0). Infected patients did not show racial differences in rates of complicated CDI or death (P ‫؍‬ 1.0). Although white patients had greater CDI rates than nonwhite patients, racial differences in CDI rates disappeared in a population for which health care access was presumed to be less racially biased. This provides evidence that apparent racial differences in CDI risks may represent health care access disparities, rather than genotypic differences. CDI represents a deviation from the paradigm that increased health care access is associated with less morbidity.

show abstract

contrasting

confidence: 46%

Racial Differences in Clostridium difficile Infection Rates Are Attributable to Disparities in Health Care Access

Mao

Kelly

Machan

2015

Antimicrob Agents Chemother

View full text Add to dashboard Cite

show abstract

“…Previous studies have suggested that black race may be protective of incident CDI 38–40 whereas prior studies of recurrent CDI have not assessed race. 12–14 The observed association between black race and CDI recurrence in the present study may be mediated by factors that influence the microbiome such as diet, biological differences such as a difference in mean serum albumin level, 41 or socioeconomic factors such as insurance status, access to medicines, or nursing home residency status.…”

Section: Discussionmentioning

confidence: 96%

Proton Pump Inhibitors and Risk for Recurrent Clostridium difficile Infection Among Inpatients

Freedberg

Salmasian

Friedman

et al. 2013

American Journal of Gastroenterology

101

View full text Add to dashboard Cite

Objectives Observational studies suggest that proton pump inhibitors (PPIs) are a risk factor for incident Clostridium difficile infection (CDI). Data also suggest an association between PPIs and recurrent CDI, although large-scale studies focusing solely on hospitalized patients are lacking. We therefore performed a retrospective cohort analysis of inpatients with incident CDI to assess receipt of PPIs as a risk factor for CDI recurrence in this population. Methods Using electronic medical records, we identified hospitalized adult patients between December 1, 2009 and June 30, 2012 with incident CDI, defined as a first positive stool test for C. difficile toxin B and who received appropriate treatment. Electronic records were parsed for clinical factors including receipt of PPIs, other acid suppression, non-CDI antibiotics, and comorbidities. The primary exposure was in-hospital PPIs given concurrently with C. difficile treatment. Recurrence was defined as a second positive stool test 15 to 90 days after the initial positive test. C. difficile recurrence rates in the PPI exposed and unexposed groups were compared with the log-rank test. Multivariable Cox proportional hazards modeling was performed to control for demographics, comorbidities, and other clinical factors. Results We identified 894 inpatients with incident CDI. The cumulative incidence of CDI recurrence in the cohort was 23%. Receipt of PPIs concurrent with CDI treatment was not associated with C. difficile recurrence (HR 0.82; 95% CI 0.58–1.16). Black race (HR 1.66, 95% CI 1.05–2.63), increased age (HR 1.02, 95% CI 1.01–1.03), and increased comorbidities (HR 1.09, 95% CI 1.04–1.14) were associated with CDI recurrence. In light of a higher 90-day mortality seen among those who received PPIs (log-rank p = 0.02), we also analyzed the subset of patients who survived to 90 days of follow-up. Again, there was no association between PPIs and CDI recurrence (HR 0.87; 95% CI 0.60–1.28). Finally, there was no association between recurrent CDI and increased duration or dose of PPIs. Conclusions Among hospitalized adults with C. difficile, receipt of PPIs concurrent with C. difficile treatment was not associated with CDI recurrence. Black race, increased age, and increased comorbidities significantly predicted recurrence. Future studies should test interventions to prevent CDI recurrence among high risk inpatients.

show abstract

“…Colectomy does not protect against CDI; rather, it may increase the risk of CDI in patients with ileostomies and ileo-anal reservoirs (J-pouch) 17 18. As the current case report indicates, patients with an ileorectal anastomosis following colectomy may acquire CDI.…”

Section: Discussionmentioning

confidence: 83%

Faecal microbiota transplantation for recurringClostridium difficileinfection in a patient with Crohn's disease and ileorectal anastomosis

et al. 2016

View full text Add to dashboard Cite

Faecal microbiota transplantation (FMT) is increasingly being used to treat refractory and recurring Clostridium difficile infection (CDI). Although FMT appears to be safe and highly effective in patients with a preserved colon and immunocompetence, its use in patients with inflammatory bowel disease (IBD) who are on immunomodulating therapies is controversial. In particular, patients who have undergone colectomy may have different treatment responses to FMT. In this case report, we describe the successful use of FMT in a female patient aged 19 years with Crohn's disease who underwent ileorectal anastomosis following colectomy. She had recurrent CDIs that were refractory to metronidazole, pulse-tapered vancomycin and fidaxomicin treatments. She underwent 2 FMTs, which were performed via sigmoidoscopy; her mother served as a donor. Follow-up was conducted for 12 months and indicated sustained remission of CDI.

show abstract

Clostridium Difficile of the Ileum Following Total Abdominal Colectomy, With or Without Proctectomy

Cited by 20 publications

References 23 publications

Racial Differences in Clostridium difficile Infection Rates Are Attributable to Disparities in Health Care Access

Racial Differences in Clostridium difficile Infection Rates Are Attributable to Disparities in Health Care Access

Proton Pump Inhibitors and Risk for Recurrent Clostridium difficile Infection Among Inpatients

Faecal microbiota transplantation for recurringClostridium difficileinfection in a patient with Crohn's disease and ileorectal anastomosis

Contact Info

Product

Resources

About