Immediate versus Delayed Emergency General Surgery is Associated with a Higher Incidence of C. difficile infection.

Author(s):
Adrian Coleoglou Centeno; Christopher Horn; Rohit Rasane; Marlon Torres; Qiao Zhang; Kelly Marie Bochicchio; Obeid Ilahi; Grant Bochicchio

Background:

Clostridium difficile infection (CDI) remains an increasingly important condition associated with surgical patients. Studies evaluating the incidence of CDI and its impact on outcomes in patients undergoing emergency general surgery (EGS) are scarce.

Hypothesis:

We hypothesize that patients undergoing an EGS procedure have a high incidence of CDI.

Methods:

Five hundred and fifty one patients that were clinically suspicious for CDI after undergoing an EGS procedure were followed prospectively. Diagnosis of C. difficile was made using the toxin assay. Demographics, surgical procedure, hospital stay, comorbidities and mortality were obtained. We then compared CDI positive and CDI negative patients using univariate analysis with chi-square and students T-test for categorical and continuous variables respectively.

Results:

The total incidence of CDI was 12.9% (71 patients). There was no significant difference in age, gender, race or BMI. The mean days for CDI diagnosis were 11.45 +/- 8.71 from admission and 10 +/- 8.6 postoperatively. CDI positive and negative patients were treated with antibiotics for a similar period of time prior to being tested for suspicion of CDI (10.52 +/-9.11 vs. 10.27 +/-10.53, p=0.85). Patients who tested positive for C. difficile underwent a surgical intervention earlier than those who did not, (0.92 days vs. 3.23 days, p<0.0001). The most common EGS procedures, for patients with a positive CDI, were partial colectomy, 15 (21.13%); followed by small bowel resection/repair, 13 (18.31%); perforated peptic ulcer, 7 (9.9%); Laparotomy, 5 (7.04%); and Skin and Soft Tissue procedure, 5 (7.04%). Charlson comorbidity index showed no difference between the groups (4.47 vs 4.90, p=0.226). There was no statistical difference in Hospital LOS, ICU LOS and Mortality between the groups.

Conclusions:

Patients that are clinically suspicious for CDI, undergoing an early EGS procedure, have a higher incidence of CDI with 12.9%. Bowel resections appear to be at increased risk for CDI. Clinicians should have a high index of suspicion and low threshold for testing C. difficile in high risk EGS patients. Further prospective studies are needed to evaluate this population.