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Clostridium difficile on a Surgical Service

A study to evaluate the epidemiology of Clostridium difficile colitis in a subset of patients admitted specifically to a surgical service was conducted by investigators from Beth Israel Deaconess Medical Center and Harvard Medical School in Boston, Massachusetts. C difficile colitis is an increasingly prevalent nosocomial infection that can prolong hospitalization and affect patient outcome adversely. Although this disease has been investigated extensively in patients admitted to medical services, the incidence and risk factors for the development of this disease in patients admitted to a surgical service have not been studied. Over a 5-month period, 21 (5.6%) of 374 patients admitted to the general, vascular, thoracic, and urologic surgery services developed symptomatic C difficile colitis (defined as more than three bowel movements per 24 hours and a positive cytotoxin assay or culture). Factors that independently predisposed to infection included admission from a skilled-care facility, use of the antibiotic cefoxitin, and an operative procedure for bowel obstruction. Other factors associated with C difficile colitis included colectomy, treatment with any antibiotic, nasogastric tube suction, advanced age, and prior antibiotic treatment. Abdominal pain and fever also were more common in patients with C difficile colitis. Morbidity included prolonged hospitalization in all patients and urgent colectomy in one. It was concluded that C difficile colitis frequently affects surgical patients, producing morbidity ranging from mild diarrhea to life-threatening illness. A variety of factors, many of which are associated with intestinal stasis, predispose to the development of C difficile colitis. FROM: Kent KC, Rubin MS, Wroblewski L, Hanff PA, Silen W. The impact of Clostridium difficile on a surgical service: a prospective study of 374 patients. Ann Surg 1998;227:296-301.