<i>Clostridium difficile</i> infection after ileostomy closure and anastomotic failure in rectal cancer surgery patients

Kim, Young Il; Yu, Chang Sik; Kim, Yang Soo; Kim, Chan Wook; Lee, Jong Lyul; Yoon, Yong Sik; Park, In Ja; Lim, Seok‐Byung; Kim, Jin Cheon

doi:10.1093/bjsopen/zrac026

Cited by 5 publications

(9 citation statements)

References 32 publications

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“…Despite this, with the reversal of faecal diversion, the rapid change in the environment of the intestinal cavity may stimulate the breeding of some conditional pathogens, such as Clostridium difficile, which increases the risk of infection and anastomotic leakage. 75 Therefore, the use of local antibiotics before the reversal of faecal diversion may be necessary. 76 In addition to immature goblet cells, we also demonstrated defective differentiation of goblet cells caused by the absence of mechanical stimulation in the defunctioned intestine.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, our data showed that the antimicrobial peptides of the epithelium in the defunctioned intestine were significantly increased, compensating for the defective function of the intestinal barrier. Despite this, with the reversal of faecal diversion, the rapid change in the environment of the intestinal cavity may stimulate the breeding of some conditional pathogens, such as Clostridium difficile , which increases the risk of infection and anastomotic leakage 75 . Therefore, the use of local antibiotics before the reversal of faecal diversion may be necessary 76 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Dissecting the effect of ileal faecal diversion on the intestine using single‐cell sequencing

Pan

et al. 2023

Clinical & Translational Med

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Background Although ileal faecal diversion is commonly used in clinical settings, complications accompany it. Elucidating the intestinal changes caused by ileal faecal diversion will help resolve postoperative complications and elucidate the pathogenic mechanisms of associated intestinal disorders, such as Crohn's disease (CD). Therefore, our study aimed to provide new insights into the effects of ileal faecal diversion on the intestine and the potential mechanisms. Methods Single‐cell RNA sequencing was performed on proximal functional and paired distal defunctioned intestinal mucosae from three patients with ileal faecal diversion. We also performed in vitro cellular and animal experiments, tissue staining and analysed public datasets to validate our findings. Results We found that the epithelium in the defunctioned intestine tended to be immature, with defective mechanical and mucous barriers. However, the innate immune barrier in the defunctioned intestine was enhanced. Focusing on the changes in goblet cells, we demonstrated that mechanical stimulation promotes the differentiation and maturation of goblet cells through the TRPA1‐ERK pathway, indicating that the absence of mechanical stimulation may be the main cause of defects in the goblet cells of the defunctioned intestine. Furthermore, we found obvious fibrosis with a pro‐fibrotic microenvironment in the defunctioned intestine and identified that monocytes may be important targets for faecal diversion to alleviate CD. Conclusions This study revealed the different transcription landscapes of various cell subsets and the potential underlying mechanisms within the defunctioned intestine, when compared to the functional intestine, based on the background of ileal faecal diversion. These findings provide novel insights for understanding the physiological and pathological roles of the faecal stream in the intestine.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Dissecting the effect of ileal faecal diversion on the intestine using single‐cell sequencing

Pan

et al. 2023

Clinical & Translational Med

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“…Out of a total of 1263 papers screened, 11 (10 retrospective cohort studies and 1 randomized controlled trial [5][6][7][8][9][10][11][12][13][14][15]) met the inclusion criteria and were analysed (Fig. 1), including a previous paper from our group [5].…”

Section: Study Population and Systematic Reviewmentioning

confidence: 99%

“…Colorectal surgery has been identified as a risk factor for Clostridium difficile infection (CDI) [1][2][3], although its occurrence is relatively rare, since as it has been reported in only 1.5% of patients [4]. However, stoma closure surgery has the highest incidence rate of CDI among abdominal procedures, ranging from 1.6 to 8.7% of cases [5][6][7][8][9][10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Clostridium difficile infection after stoma reversal surgery: a systematic review and meta-analysis of the literature

Tirelli,

Langellotti,

Lorenzon

et al. 2024

Int J Colorectal Dis

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Background Clostridium difficile infection (CDI) has been described in the early post-operative phase after stoma reversal. This systematic review aimed to describe the incidence of CDI after stoma reversal and to identify pre-operative variables correlated with an increased risk of infection. Methods A systematic review of the literature was conducted according to the PRISMA guidelines in March 2024. Manuscripts were included if reported at least one patient with CDI-associated diarrhoea following stoma reversal (colostomy/ileostomy). The primary outcome of interest was the incidence of CDI; the secondary outcome was the comparison of clinical variables (age, sex, time to stoma reversal, neo-adjuvant and adjuvant therapies after index colorectal procedure) in CDI-positive versus CDI-negative patients. A meta-analysis was performed when at least three studies reported on those variables. Results Out of 43 eligible manuscripts, 1 randomized controlled trial and 10 retrospective studies were selected, including 17,857 patients (2.1% CDI). Overall, the mean age was 64.3 ± 11.6 years in the CDI group and 61.5 ± 12.6 years in the CDI-negative group (p = 0.51), with no significant difference in sex (p = 0.34). Univariable analyses documented that the mean time to stoma reversal was 53.9 ± 19.1 weeks in CDI patients and 39.8 ± 15.0 weeks in CDI-negative patients (p = 0.40) and a correlation between neo-adjuvant and adjuvant treatments with CDI (p < 0.001). A meta-analysis was performed for time to stoma reversal, age, sex, and neo-adjuvant therapies disclosing no significant differences for CDI (stoma delay, MD 11.59; 95%CI 24.32–1.13; age, MD 0.97; 95%CI 2.08–4.03; sex, OR1.11; 95%CI 0.88–1.41; neo-adjuvant, OR0.81; 95%CI 0.49–1.35). Meta-analysis including patients who underwent adjuvant therapy evidenced a higher risk of CDI (OR 2.88; 95%CI 1.01–8.17, p = 0.11). Conclusion CDI occurs in approximately 2.1% of patients after stoma reversal. Although a trend of increased delay in stoma reversal and a correlation with chemotherapy were documented in CDI patients, the use of adjuvant therapy was the only possible risk factor documented on meta-analysis. PROSPERO registration number CRD42023484704

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Impact of Clostridium difficile Infection Versus Colonization on Postoperative Outcomes After Oncological Colorectal Surgery: An Observational Single‐Center Study With Propensity Score Analysis

Ong,

Morarasu,

Lunca

et al. 2024

Journal of Surgical Oncology

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BackgroundThere is limited research available concerning the risk anastomotic leakage in the context of Clostridium difficile infection (CDI). Herein, we aim to elucidate the correlation between CDI, encompassing both preoperative asymptomatic C. difficile carriers (CDC) and postoperative hospital acquired C. difficile infections (HA‐CDI), and the occurrence of anastomotic leakage in patients undergoing oncological colorectal surgery.MethodsThis is an observational, single‐center study. Data were sourced from surgical logs between 2018 and 2023, via the hospital's electronic system. Patients were split into three subgroups: CDC, HA‐CDI, and control group (CG). Groups were compared in terms of patient characteristics, morbidity, and mortality via Fisher's exact test and Kruskal–Wallis test. One‐to‐one propensity score matching was performed to reduce selection bias.ResultsA total of 522 patients were analyzed, split into three subgroups: CDC, n = 35; HA‐CDI, n = 27; CG, n = 460. One‐to‐one propensity score matching reduced the CG to 62 patients. Patients in the HA‐CDI group had higher rates of overall morbidity (p < 0.0001), higher rates of anastomotic leaks (p = 0.002), more surgical site infections (SSI) (p = 0.001), and a longer length of stay (26 vs. 11.2 vs. 9.3 days, p < 0.001), while patients in the CDC group had comparable rates of complications with the CG.ConclusionHA‐CDI is associated with a higher risk of anastomotic leak after oncological colorectal surgery, while asymptomatic CDC do not have higher morbidity and may be operated electively, under standard CD treatment.

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Clostridium difficile infection after ileostomy closure and anastomotic failure in rectal cancer surgery patients

Cited by 5 publications

References 32 publications

Dissecting the effect of ileal faecal diversion on the intestine using single‐cell sequencing

Dissecting the effect of ileal faecal diversion on the intestine using single‐cell sequencing

Clostridium difficile infection after stoma reversal surgery: a systematic review and meta-analysis of the literature

Impact of Clostridium difficile Infection Versus Colonization on Postoperative Outcomes After Oncological Colorectal Surgery: An Observational Single‐Center Study With Propensity Score Analysis

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