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730 A Multicenter Study of Colectomy Incidence for Clostridium difficile Infection

Sunday, March 21, 2010: 10:45 AM
Centennial I-II (Hyatt Regency Atlanta)
Amelia M. Kasper, MD , Washington University School of Medicine, St. Louis, MO
Humaa A. Nyazee, MPH , Washington University School of Medicine, St. Louis, MO
Deborah S. Yokoe, MD , Brigham and Women's Hospital and Harvard Medical School, Boston, MA
Jeanmarie Mayer, MD , University Of Utah School of Medicine, Salt Lake City, UT
Julie E. Mangino, MD , The Ohio State University Medical Center, Columbus, OH
Yosef M. Khan, MBBS, MPH , The Ohio State University Medical Center, Columbus, OH
Bala Hota, MD , Stroger Hospital of Cook County/Rush University Medical Center, Chicago, IL
L. Clifford McDonald, MD, FACP , Centers for Disease Control and Prevention, Atlanta, GA
Victoria J. Fraser, MD , Washington University School of Medicine, St. Louis, MO
Erik R. Dubberke, MD , Washington University School of Medicine, St. Louis, MO
Background: Evidence suggests the severity of Clostridium difficile infection (CDI) is increasing, but reports are scarce and frequently involve only a single center. Currently, there is no standardized surveillance system to track the number and severity of cases. We investigated the incidence of colectomy for CDI at the CDC Prevention Epicenters over 6 years.

Objective: To determine the rate of colectomy for CDI over time and by CDI onset at 5 hospitals.

Methods: Data on adult patients with toxin-positive CDI admitted from 7/2000-6/2006 were collected from electronic hospital records from 5 tertiary-care centers in the United States. Patients who underwent colectomy and had CDI were identified and chart review was conducted to assess if the colectomy was for CDI. Colectomy rates per 1,000 CDI cases were calculated. Differences in colectomy rate across facilities and by CDI onset were compared by chi-square. Differences between patients who underwent colectomy and patients who did not have a colectomy were compared by chi-square or Mann-Whitney U. Trends over time were assessed by chi-square test for trend. CDI cases were categorized according to published recommendations (McDonald, et al. ICHE. 2007. 28:140-5).

Results: 8,055 cases of toxin-positive CDI were identified; 71 case-patients had a colectomy for CDI. Patients who had a colectomy were older (median 68 vs 62 years, p=.02), were more likely to be white (83% vs 71%, p=.03), and had lower median Charlson score (median 1.0 vs. 1.0, p=.04) compared to patients with CDI who did not have a colectomy. There were no differences in the proportion who were female (42% vs. 50%, p=.27).

The overall colectomy rate was 9 / 1,000 CDI cases. The overall colectomy rate by hospital ranged from 0 to 24 / 1,000 CDI cases (p<.01) (Table). The colectomy rates by CDI onset were as follows: healthcare onset 4.1, community-onset, community associated 5.7, community-onset, study facility associated 5.0, community-onset, other healthcare facility associated 12.1, indeterminate onset cases 5.5, and unknown onset 77.5. There were no significant trends in colectomy for CDI at any individual hospital or overall over time.

Conclusions: The overall colectomy rate is low. Compared to the other CDI surveillance definitions, community onset cases with recent healthcare facility exposure had the highest rate of CDI-related colectomies. High colectomy rates among cases with unknown CDI-onset are perhaps due to self-selection of particularly severe cases presenting to referral study centers from other hospitals, and therefore no toxin results at the study hospital. Though no significant increase in colectomy rates was seen over time, there are disparities in the rates between centers, possibly reflecting true differences in the severity of the disease or thresholds for performing surgery for CDI-associated colitis.