THE IMPACT OF CLOSTRIDIUM-DIFFICILE ON A SURGICAL SERVICE - A PROSPECTIVE-STUDY OF 374 PATIENTS

Objective To evaluate the epidemiology of Clostridium difficile coliti s (CDC) in a subset of patients admitted specifically to a surgical se rvice. Summary Background Data CDC is an increasingly prevalent nosoco mial infection that can prolong hospitalization and adversely affect p atient outcome. Although this disease has been investigated extensivel y in patients admitted to medical services, the incidence and risk fac tors for the development of this disease in patients admitted to a sur gical service have not been studied. Methods Over a 5-month period, 37 4 patients admitted to the general, vascular, thoracic, and urologic s urgery services were monitored for the development of symptomatic CDC (defined as >3 bowel movements per 24 hours and a positive cytotoxin a ssay or culture). Results Twenty-one patients developed CDC (incidence , 5.6%). Factors that independently predisposed to infection included admission from a skilled care facility, use of the antibiotic cefoxiti n, and an operative procedure for bowel obstruction. Other factors ass ociated with CDC included colectomy, treatment with any antibiotic, na sogastric tube suction, advanced age, and prior antibiotic treatment. Abdominal pain and fever were also more common in patients with CDC. M orbidity included prolonged hospitalization in all patients and urgent colectomy in one. Conclusions CDC frequently affects surgical patient s, producing morbidity ranging from mild diarrhea to life-threatening illness. A variety of factors, many of which are associated with intes tinal stasis, predispose to the development of CDC.