The Surgical Management of Active Ulcerative Colitis Complicated by Clostridium difficile Infection

• Published in: Journal of gastrointestinal surgery 2013-02, Vol.17 (2), p.392-396
• Main Authors: Chu, Edward W., Ecker, Brett L., Garg, Malika, Divino, Celia M.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Anastomosis; Antibiotics; Blood transfusions; Clostridioides difficile; Clostridium difficile; Clostridium Infections - complications; Colectomy; Colitis, Ulcerative - complications; Colitis, Ulcerative - surgery; Data processing; Feces; Female; Gastroenterology; Hospitals; Humans; Inflammatory bowel disease; Intestine; Male; Medicine; Medicine & Public Health; Middle Aged; Mortality; Original Article; Patients; Retrospective Studies; Sepsis; Steroids; Surgery; Surgical site infections; Toxins; Ulcerative colitis; Wound infection; Young Adult
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-012-2031-2

Introduction Clostridium difficile stool toxin is detected in 5–20 % of patients with acute exacerbations of ulcerative colitis (UC). There is little data regarding the safety of surgery for UC with concurrent C. difficile . Methods A retrospective review was performed of 23 patients undergoing colectomy for refractory UC complicated by C. difficile infection between January 2002 and June 2012. Patients were stratified into those who completed a full antibiotic course for C. difficile infection prior to surgery (group A, n  = 7) and those who proceeded directly to surgery (group B, n  = 16). The primary endpoints of perioperative mortality, ICU requirement, reoperation, readmission, and surgical site infection were assessed within 30 days after surgery. Results Postoperatively, no mortalities, ICU admissions, readmission, or reoperations occurred. One group A patient developed a superficial wound infection, which resolved with a course of outpatient antibiotics (14 vs. 0 %, p  = 0.12). Average days until return of bowel function and average length of postoperative stay were comparable between group A and B (3.9 vs. 3.6 days, p  = 0.70; 7.0 vs. 6.9 days, p  = 0.87; respectively). Ninety-one percent of patients subsequently underwent ileal pouch–anal anastomosis. Conclusion Colectomy for ulcerative colitis complicated by C. difficile can be performed safely without completing a course of antibiotic therapy.