Is <i>Clostridium difficile</i> infection a particular problem after reversal of ileostomy?

Randall, J.K.; Young, Bernadette C.; Patel, Gia M.; Fitzgerald, Anthony J.; George, Bruce

doi:10.1111/j.1463-1318.2009.02139.x

Cited by 28 publications

(36 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This can underestimate infections, as many of infection [27] . In a large series of 13245 United States patients undergoing ileostomy closure, Wilson et al [28] , report a 1.6% incidence of pseudomembranous colitis.…”

Section: Discussionmentioning

confidence: 99%

Increased postoperative complications after protective ileostomy closure delay: An institutional study

Rubio-Perez¹,

León²,

Pastor³

et al. 2014

WJGS

View full text Add to dashboard Cite

AIM:To study the morbidity and complications associated to ileostomy reversal in colorectal surgery patients, and if these are related to the time of closure. METHODS:A retrospective analysis of 93 patients, who had undergone elective ileostomy closure between 2009 and 2013 was performed. Demographic, clinical and surgical variables were reviewed for analysis. All complications were recorded, and classified according to the Clavien-Dindo Classification. Statistical univariate and multivariate analysis was performed, setting a P value of 0.05 for significance. RESULTS:The patients had a mean age of 60.3 years, 58% male. The main procedure for ileostomy creation was rectal cancer (56%), and 37% had received preoperative chemo-radiotherapy. The average delay from creation to closure of the ileostomy was 10.3 mo. Postoperative complications occurred in 40% of the patients, with 1% mortality. The most frequent were ileus (13%) and wound infection (13%). Pseudomembranous colitis appeared in 4%. Increased postoperative complications were associated with delay in ileostomy closure (P = 0.041). Male patients had more complications (P = 0.042), mainly wound infections (P = 0.007). Pseudomembranous colitis was also associated with the delay in ileostomy closure (P = 0.003). End-to-end intestinal anastomosis without resection was significantly associated with postoperative ileus (P = 0.037). CONCLUSION:Although closure of a protective ileostomy is a fairly common surgical procedure, it has a high rate of complications, and this must be taken into account when the indication is made. The delay in stoma closure can increase the rate of complications in general, and specifically wound infections and colitis.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Protective ileostomy; Stomas; Stoma-related complications; Surgical infections; Colorectal surgery Core tip: Protective ileostomies are widely used by surgeons for the protection of anastomoses, but they imply a second intervention for reversal. Despite being considered a minor intervention, ileostomy reversal does not lack complications. Adjuvant treatment, complications from the first intervention, or low-priority consideration can delay the closure of the stoma. In our study, we reviewed all complications following ileostomy reversal and found they were considerably high (40%), and increased as did the time (in months) until closure (P = 0.041). In multivariate analysis, male patients had more complications (P = 0.042), mainly wound infections (P = 0.007). Pseudomembranous colitis was also associated with the delay in ileostomy closure (P = 0.003).Rubio-Perez I, Leon M, Pastor D, Diaz Dominguez J, Cantero R. Increased postoperative complications after protective ileostomy closure delay: An institutional study. World J Gastrointest Surg 2014; 6(9): 169-174 Available from:

show abstract

Section: Discussionmentioning

confidence: 99%

Increased postoperative complications after protective ileostomy closure delay: An institutional study

Rubio-Perez¹,

León²,

Pastor³

et al. 2014

WJGS

View full text Add to dashboard Cite

show abstract

“…Randall et al 10 looked retrospectively into patients who were coded to have had closure of ileostomy and subsequent C. difficile infection. Six of the 143 patients who had reversal of ileostomy developed C. difficile infection (4.2%).…”

Section: Discussionmentioning

confidence: 99%

Clostridium difficileinfection after ileostomy closure mimicking anastomotic leak

2015

View full text Add to dashboard Cite

Clostridium difficile infection is linked to antibiotic exposure, with elderly and immunocompromised hospitalised patients being particularly at risk. The symptoms range from mild diarrhoea to life-threatening fulminant colitis. We describe an unusual presentation of C. difficile infection after closure of ileostomy in a healthy 60-year-old man with a history of low anterior resection and defunctioning ileostomy for rectal tumour. On the third day postoperatively, the patient developed left lower abdominal pain and profuse diarrhoea. With worsening symptoms and steadily increasing inflammatory markers over the following few days, concerns were raised about an anastomotic leak with pelvic abscess. CT of the abdomen/pelvis on day 7 surprisingly showed colitis in the neorectum/sigmoid colon. A stool test confirmed C. difficile infection.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Some not so frequent circumstances of CDI revealed in our study are procedures after previous colo-rectal surgery, like ileostomy loop closures. Even if CDI is an uncommon complication for such a small intervention, patients undergoing stoma closure are at high risk for an adverse outcome if they have CDI [28,29].The very small number of cases in the oncological ward, just 2 patients out of 164, may be encouraging the supposition that chemotherapy is not a predisposing risk factor for CDI, but for the early onset of CDI negative diarrhea [14]. We need to take into account that the median stay in the oncology clinic is only 3 days.…”

mentioning

confidence: 99%

Clostridium Difficile Infection - An Optimistic View

Frunza¹,

Rotundu²,

Morărașu³

et al. 2017

Surgery

View full text Add to dashboard Cite

Journal of Surgery IntroductionClostridium difficile is an anaerobic, Gram-positive, spore-forming, toxin-producing bacteria identified as a cause of colitis associated with antibiotic use [1]. Previous exposure to antibiotics is the most important risk factor for CDI, leading to modification of the normal flora of the colon and decreasing the intestine's resistance to colonization [2]. Other risk factors for CDI are inflammatory bowel disease, immunodeficiency, hypoalbuminemia, malignancies, organ transplantation and mechanical bowel preparation. Despite the development of CDI therapy there is a growing incidence, severity, mortality and recurrence of this condition [3]. The high rate of recurrent CDI raises a question mark over current treatment recommendations of the first episodes of CDI [4,5]. Materials and MethodsWe identified all reported cases of CDI during the period of 2014-2016 using the digital database of the center for control, surveillance, and prevention of transmissible diseases in the Regional Oncologic Institute Iasi. All cases are registered in the database immediately after diagnosis, followed by epidemiological investigation and standardized protocols for isolation and protection of contacts. The admission charts were studied to extract the following information: age, sex, date of admission and release, date of CDI confirmation and toxin negativity. We also checked for antibiotic use in the last 3 months, administration of gastricantisecretory medication, previous hospitalization or contact with CDIconfirmed patients. For the surgical cases we gathered data about the date and type of intervention performed. Diagnosis of Clostridium difficile colitisEven if symptoms can be variable, typical symptom is watery diarrhea up to 15-30 stools per day [1,3]. Some patients can complain AbstractBackground: Clostridium difficile infection (CDI) is one of the most common infectious complications affecting vulnerable patients, i.e., after surgery or immunosuppressive therapies, posing a significant risk in an oncological unit. Materials and methods:We analyzed data recovered from 164 cases of CDI during the period of 2014-2016 in the Regional Oncologic Institute Iasi, majority admitted in the surgical and hematological units. In all cases diagnostic was confirmed if stool samples tested positive for GDH and at least one of the toxins A or B. Results:The study shows a large population of elder patients (median age 64 years) with female dominance (54%). Out of 117 surgical cases 64% had surgical procedures on the gastro-intestinal tract. Although 20% of patients had equivocal symptoms from admission, the average interval (from admission) until first symptoms developed was 7 days. The confirmation of the diagnosis came in the next day/24h in 68% of cases, leading to initiation of efficient therapy. Although CDI is regarded as an antibiotic associated disease, our data revealed that only one third of patients received antibiotic treatment in the last 3 months. Among the risk factors that may have an influen...

show abstract

Is Clostridium difficile infection a particular problem after reversal of ileostomy?

Abstract: Ileostomy closure may carry a higher risk of CDI.

Cited by 28 publications

References 9 publications

Increased postoperative complications after protective ileostomy closure delay: An institutional study

Increased postoperative complications after protective ileostomy closure delay: An institutional study

Clostridium difficileinfection after ileostomy closure mimicking anastomotic leak

Clostridium Difficile Infection - An Optimistic View

Contact Info

Product

Resources

About