Incidence, risk factors, and outcome of Clostridioides difficile infection following urological surgeries

Abstract

Purpose To assess the incidence, risk factors, and clinical outcomes associated with (Clostridioides difficile infection) CDI following urological surgery, which is the leading cause of nosocomial diarrhea and a growing public health burden. Methods We queried the National Surgical Quality Improvement Program (NSQIP) to identify patients undergoing urological surgery in 2015-2016. We evaluated the 30-day incidence and factors associated with postoperative CDI and 30-day hospital readmission and length of stay as secondary outcomes. Among the subset of patients undergoing radical cystectomy with urinary diversion (surgery with highest CDI incidence) we used multivariable logistic regression analysis to evaluate independent clinical and demographic factors associated with postoperative CDI. Results We identified 98,463 patients during the study period. The overall 30-day incidence of CDI was 0.31%, but varied considerably across surgery type. The risk of CDI was greatest following radical cystectomy with urinary diversion (2.72%) compared to all other urologic procedures (0.19%) and was associated with increased risk of hospital readmission (p < 0.0001), re-operation (p < 0.0001), and longer mean length of stay (p < 0.0001) in this cohort. Among patients undergoing radical cystectomy with urinary diversion, multivariable logistic regression revealed that preoperative renal failure (OR: 5.30, 95% CI 1.13-24.9, p = 0.035) and blood loss requiring transfusion (OR: 1.67, 95% CI 1.15-2.44, p = 0.0075) were independently associated with CDI. Conclusions In a nationally representative cohort, the incidence of CDI was low but varied substantially across surgery types. CDI was most common following radical cystectomy and associated with potentially modifiable factors such as blood transfusion and significantly longer length of stay.

A Systematic Literature Review on Risk Factors for and Timing of Clostridioides difficile Infection in the United States

“…However, six of seven studies on hematologic malignancies reported a significant risk for CDI, the aOR ranging from 1.74 (95% CI 1.48-2.06) to 12.9 (95% CI 3.7-44.8) [31,34,38,64,[82][83][84]. Among six studies of metastatic cancer, significant risk was reported in three, and one reported a protective effect [34,54,62,64,82,85]. Diabetes was reported in 15 studies, with four reports of significantly increased risk and six reports of a protective effect.…”

“…Twenty-six articles included a risk estimate for sex (Fig. 2); a significantly higher risk of CDI in women compared with men was reported in 12 studies [28,43,[47][48][49][50][51][52][53][54][55]. This ranged from an aOR of 1.02 (95% CI 1.00-1.04; p value not presented) in a mixed study population in a large database study [34] to an aOR of 6.3 (95% CI 1.7-24.0; p \ 0.01) in patients with urinary tract infections (UTIs) [50].…”

“…Five of six studies found fluid and electrolyte disorder to strongly increase the risk of CDI (aOR range 1.46 [95% CI 1.17-1.84] to 9.96 [95% CI 9.37-10.60]) [30,31,34,42,64,70]. Bowel disease [30, 42-44, 48-51, 69, 74-77], coagulation disorders [31,34,42,47,49,52,54,62,64,70], and being underweight [31,32,34,42,44,49,52,64,78,79] were also found to be possible risk factors. Obesity appeared to have a protective effect and decreased the risk of CDI in four studies, with aORs ranging from 0.252 (95% CI 0.058-0.945) to 0.81 (95% CI 0.74-0.87) [34,49,52,80], although no significant effect was found in the other seven studies [42,48,53,63,64,78,81].…”

Clostridioides difficile Infections among Pediatric Patients Hospitalized at an Oncology Department of a Tertiary Hospital in Poland

“…A decrease inhemoglobin content below 7g/dl is an indication for the transfusion of blood products since it constitutes a direct risk to life [ 8 ]. Significant abnormalities in blood morphology, which are an indication for transfusion, are considered by many researchers to be a marker of a severe course of CDI [ 9 ]. The period after chemotherapy where the lowest number of blood cells is present (the nadir period) constitutes a significant risk of severe complications and infections.…”