Prevalence of Clostridium Difficile Infection in Patients After Radical Cystectomy and Neoadjuvant Chemotherapy

Abstract

Background and Objectives:Clostridium Difficile is the most common cause of nosocomial infectious diarrhea. This study evaluates the prevalence and predictors of Clostridium Difficile infections in patients undergoing radical cystectomy with or without neoadjuvant chemotherapy.Methods:Retrospective chart review was performed of all patients undergoing cystectomy and urinary diversion at a single institution from 2011–2017. Infection was documented in all cases with testing for Clostridium Difficile polymerase chain reaction toxin B. Patient and disease related factors were compared for those who received neoadjuvant chemotherapy vs. those who did not in order to identify potential risk factors associated with C. Difficile infections. Chi squared test and logistic regression analysis were used to determine statistical significance.Results:Of 350 patients who underwent cystectomy, 41 (11.7%) developed Clostridium Difficile in the 30 day post-operative period. The prevalence of C. Difficile infection was higher amongst the patients undergoing cystectomy compared to the non-cystectomy admissions at our hospital (11.7 vs. 2.9%). Incidence was not significantly different among those who underwent cystectomy for bladder cancer versus those who underwent the procedure for other reasons. Median time to diagnosis was 6 days (range 3–28 days). The prevalence of C. Diff infections was not significantly different among those who received neoadjuvant chemotherapy vs. those who did not (11% vs. 10.4% p = 0.72). A significant association between C. Difficile infection was not seen with proton pump inhibitor use (p = 0.48), patient BMI (p = 0.67), chemotherapeutic regimen (p = 0.94), individual surgeon (p = 0.54), type of urinary diversion (0.41), or peri-operative antibiotic redosing (p = 0.26).Conclusions:Clostridium Difficile infection has a higher prevalence in patients undergoing cystectomy. No significant association between prevalence and exposure to neoadjuvant chemotherapy was seen.

Incidence, risk factors, and outcome of Clostridioides difficile infection following urological surgeries

“…Among nearly 5000 patients undergoing cystectomy with urinary diversion, we found that the incidence of CDI was 2.6%. This rate is lower than prior studies which reported a rate of 8.8% in a series of 522 patients and 11.7% in a series of 350 patients and may reflect a more representative national sample [ 9 , 10 ]. However, a lower incidence may also relate to methodological differences in capturing CDI which is limited to 30 days after surgery within NSQIP.…”

“…Nosocomial infections are significant contributors to adverse patient outcome and increased healthcare expenditure after urological surgery [ 9 ]. Yet, little information exists in the literature regarding the effects of CDI after urological surgery.…”

“…Yet, little information exists in the literature regarding the effects of CDI after urological surgery. Previous retrospective, single-institution studies have begun to characterize the risk of CDI after urologic surgeries of larger scale, such as radical cystectomy [ 9 ]. However, to our knowledge, no cross-sectional national analyses have been performed to study this question across the span of common urological surgeries.…”

A Prospective Program to Reduce the Clinical Incidence of Clostridium difficile Colitis Infection after Cystectomy

“…The generalizability of our results may be limited due to the higher incidence rate of CDI compared to other institutions [16][17][18][19] . However, CDI rates are rising and recent reports suggest that CDI rates in cystectomy patients may be even higher at other institutions 5,20 . Moreover, multiple agencies (ACG, IDSA, CDC) have produced M A N U S C R I P T…”

“…Cystectomy patients are at higher risk of CDI than the general patient population due to their increased age, underlying comorbidities, and recent antibiotic exposure with published rates of CDI in cystectomy patients ranging from 1.4-14% [16][17][18][19][20][21] . It has been demonstrated that the development of CDI after cystectomy is associated with a 2.5-fold increase in mortality and adds approximately $22,634 in cost per hospitalization per patient 17 .…”