Acute Abdomen and &lt;i&gt;Clostridium difficile&lt;/i&gt; Colitis: Still a Lethal Combination

Klipfel, Adam; Schein, Moshe; Fahoum, Bashar; Wise, Leslie

doi:10.1159/000018821

Cited by 54 publications

(32 citation statements)

References 8 publications

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“…4,10 This form of disease may require prompt surgical intervention and is associated with appreciable mortality. [10][11][12][13] Although there are no specific criteria for defining these cases, patients typically have marked systemic signs of infection including fever and leukocytosis. Abdominal pain may be severe and there may be frank peritoneal signs.…”

mentioning

confidence: 99%

Outcome After Colectomy for Clostridium Difficile Colitis

Longo¹,

Mazuski²,

Virgo³

et al. 2004

Diseases of the Colon &Amp; Rectum

187

100

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Patients with fulminant C. difficile colitis often present with an unexplained abdominal illness with a marked leukocytosis that rapidly progresses to shock and peritonitis. Although frequently developed during a hospitalization and often after a surgical procedure, it may develop outside of a hospital setting. Diarrhea may be absent and stool cytology may be negative for C. difficile toxin. Perforation and infarction are frequently found at surgery. In those patients who survive, a prolonged hospitalization is common. Mortality from fulminant C. difficile colitis remains high despite surgical intervention.

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mentioning

confidence: 99%

Outcome After Colectomy for Clostridium Difficile Colitis

Longo¹,

Mazuski²,

Virgo³

et al. 2004

Diseases of the Colon &Amp; Rectum

187

100

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“…Patients had a median of three antibiotics (range, 1-6), for a median of 10 days (range, 0-59 days; Table 1). Of patients, 71% (12) had been treated with a cephalosporin as part of their antibiotic regimen. Other commonly used antibiotics were quinolones (Moxifloxacin and/or Levofloxacin, n = 4; Ciprofloxacin, n = 3), Co-Amoxiclav (n = 4), and Clarithromycin and Gentamicin, each used in three patients.…”

Section: Resultsmentioning

confidence: 99%

“…In some studies, 30-day postoperative mortality is akin to ours, such as Dallal et al 8 at 57%. However, other rates vary immensely; Bryn et al 5 found postoperative in-hospital mortality after colectomy for C. difficile colitis to be 34%, while Klipfel et al 12 reported a higher rate of 80%.…”

Section: Discussionmentioning

confidence: 99%

Emergency subtotal colectomy for fulminant Clostridium difficile colitis – is a surgical solution considered for all patients?

Gash

Brown

Pullyblank

2010

annals

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Ann R Coll Surg Engl 2010; 92: 56-60 56Clostridium difficile is the most common cause of hospitalacquired diarrhoea and has been a serious problem in the UK. Infection produces a spectrum of disease, from mild abdominal pain and diarrhoea, to fulminant pseudomembranous colitis. This nosocomial infection associated with antibiotic use, causes more deaths per year than methicillin-resistant Staphylococcus aureus (MRSA). In 2007, there were 49,785 reported cases of C. difficile infection in England.1 The UK Government is now investing £230 million per year in order to cut C. difficile related deaths. 2In 2007, C. difficile infection was documented on 8324 death certificates in England and Wales. This was an increase of 28%, from 6480, in the previous year. It was recorded as the underlying cause of death in 4056 of these cases and mentioned on a further 4268 certificates.3 Our own trust saw a rise in C. difficile related deaths from 13 in 2001 to 158 in 2007. 3 This was partly due to an increase in reporting, as C. difficile deaths were not accurately reported until 2007. Nationally, between 2004 and 2007, there was a rising incidence of the 027-ribotype strain of C. difficile and in our trust, a growing number of patients developed fulminant colitis. With an increasing number of these patients requiring subtotal colectomy for pseudomembranous colitis, we reviewed a series of these cases. Patients and MethodsThis study was a retrospective analysis of patients who underwent a subtotal colectomy for fulminant C. difficile colitis in a large hospital trust, over a period of 18 months, Clostridium difficile has been an increasing problem in UK hospitals. At the time of this study, there was a high incidence of C. difficile within our trust and a number of patients developed acute fulminant colitis requiring subtotal colectomy. We review a series of colectomies for C. difficile, examining the associated morbidity and mortality and the factors that predispose to acute fulminant colitis. PATIENTS AND METHODS This is a retrospective study of patients undergoing subtotal colectomy for C. difficile colitis in an NHS trust over 18 months. Case notes were reviewed for antibiotic use, duration of diarrhoea, treatment, blood results, preoperative imaging and surgical morbidity and mortality. RESULTS A total of 1398 patients tested positive for C. difficile in this period. Of these, 18 (1.29%) underwent colectomy. All were emergency admissions, 35% medical, 35% surgical, 24% neurosurgical and 6% orthopaedic. In the cohort, 29% were aged less than 65 years. Patients had a median of three antibiotics (range, 1-6), for a median of 10 days (range, 0-59 days). Median length of stay prior to C. difficile diagnosis was 13 days. Subtotal colectomy was performed a median of 4 days (range, 0-23 days) after diagnosis. Postoperative mortality was 53% (9 of 17). The median C-reactive protein level for those who died was 302 mg/l, in contrast to 214 mg/l in the survival group. Whilst 62% of all C. difficile cases were medical, the colectomy...

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“…The surgical procedure of choice for toxic megacolon is total colectomy with preservation of rectum and diver ting ileostomy [6,7,13,31] . Outcomes are worse if a partial colectomy is performed, perhaps owing to residual dis eased bowel left in place [3,4,29,34] .…”

Section: Discussionmentioning

confidence: 99%

“…It produces toxins A and B, causing severe mu cosal destruction and pseudomembrane formation [15] . Clindamycin, cephalosporins and fluoroquinolones are the most common antibiotics associated with C. difficile infection [3,6,7] . The prevalence of C. difficile colitis has been increasing [8] .…”

Section: Introductionmentioning

confidence: 99%

Toxic megacolon associatedClostridium difficilecolitis

Sayedy

Kothari²,

Richards

2010

WJGE

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Toxic megacolon is a severe complication of Clostridium difficile (C. difficile ) colitis. As the prevalence of C. difficile colitis increases and treatments become more refractory, clinicians will encounter more patients with C. difficile associated toxic megacolon in the future. Here, we review a case of toxic megacolon secondary to C. difficile colitis and review the current literature on diag nosis and management. We identify both clinical and radiologic criteria for diagnosis and discuss both medical and surgical options for management. Ultimately, we recommend using the Jalen criteria in conjunction with daily abdominal radiographs to help establish the dia gnosis of toxic megacolon and to make appropriate treat ment recommendations. Aggressive medical manage ment using supportive measures and antibiotics should remain the mainstay of treatment. Surgical intervention should be considered if the patient does not clinically improve within 23 d of initial treatment.

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Acute Abdomen and <i>Clostridium difficile</i> Colitis: Still a Lethal Combination

Cited by 54 publications

References 8 publications

Outcome After Colectomy for Clostridium Difficile Colitis

Outcome After Colectomy for Clostridium Difficile Colitis

Emergency subtotal colectomy for fulminant Clostridium difficile colitis – is a surgical solution considered for all patients?

Toxic megacolon associatedClostridium difficilecolitis

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