Top

Journal of Gastrointestinal Surgery

Published in:

01-05-2009 | Original Article

Long-Term Follow-Up of Patients with Fulminant Clostridium difficile Colitis

Authors: Aaron T. Miller, Parissa Tabrizian, Alexander J. Greenstein, Andrew Dikman, John Byrn, Celia Divino

Published in: Journal of Gastrointestinal Surgery | Issue 5/2009

Abstract

Purpose

The purpose of this study was to determine the long-term survival rate, rate of gastrointestinal continuity restoration, and rate of recurrence following an attack of fulminant Clostridium difficile colitis.

Material and Methods

Fulminant C. difficile colitis was defined as any patient who had a bout of C. difficile colitis and required surgical intervention after failing medical therapy. These patients were found through a pathological database search. Follow-up phone calls were made to any patient who survived at least 30 days after being discharged from the hospital following surgical intervention (long-term survivor group).

Results

A total of 49 patients were involved in the study. The 30-day mortality rate was 57% (28/49), with an in-hospital mortality rate of 49%. The 5-year survival rate for the long-term survival group was 38% (8/21) and 16.3% for all patients. Gastrointestinal continuity was restored in 20% of the patients. There was one documented recurrence of C. difficile colitis

Conclusion

Patients who have a bout of fulminant C. difficile colitis have a poor prognosis of surviving longer than 5 years. Restoring gastrointestinal continuity is uncommon and usually reserved for patients with few co-morbidities. Recurrent C. difficile colitis after surgical resection is a rare occurrence

Elliot B, Chang BJ, Golledge CL, Riley TV. Clostridium difficile-associated diarrhoea. Intern Med J. 2007;37:561–568. doi:10.1111/j.1445-5994.2007.01403.x.CrossRef

Zerey M, Paton LB, Lincourt AE, Gersin KS, Kercher KW, Heniford TB. The burden of Clostridium difficile in surgical patients in the United States. Surg Infect 2007;8(6):557–566.CrossRef

Adams SD, Mercer DW. Fulminant Clostridium difficile colitis. Curr Opin Crit Care 2007;13:450–455.PubMedCrossRef

Koss K, Clark MA, Sanders DSA, Morton D, Keighley MRB, Goh J. The outcome of surgery in fulminant Clostridium difficile colitis. Colorectal Dis 2005;8:149–154.CrossRef

Byrn JC, Maun DC, Gingold DS, Baril DT, Ozao JJ, Divino CM. Predictors of mortality after colectomy for fulminant Clostridium difficile colitis. Arch Surg 2008;143(2):150–154.PubMedCrossRef

Hermsen JL, Dobrescu C, Kudsk KA. Clostridium difficile infection: a surgical disease in evolution. J Gastrointest Surg 2008;12:1512–1517.PubMedCrossRef

Longo WE, Mazuski JE, Virgo KS, Lee P, Bahadursingh AN, Johnson FE. Outcome after colectomy for Clostridium difficile colitis. Dis Colon Rectum 2004;47(10):1620–1626.PubMedCrossRef

Greenstein AJ, Byrn JC, Zhang LP, Swedish KA, Jahn AE, Divino CM. Risk factors for the development of fulminant Clostridium difficile colitis. Surgery 2008;143(5):623–629.PubMedCrossRef

Riccardi R, Rothenberger DA, Madoff RD, Baxter NN. Increasing prevalence and severity of Clostridium difficile colitis in hospitalized patients in the United States. Arch Surg 2007;142(7):624–631.CrossRef

10.

Lamontagne F, Labbe AC, Haeck, Lesur O, Lalancette M, Patino C, Leblanc M, Laverdiere M, Pepin J. Impact of emergency colectomy on survival of patients with fulminant Clostridium difficile colitis during an epidemic caused by a hypervirulent strain. Ann Surg 2007;245(2):267–272.PubMedCrossRef

11.

Dallal RM, Harbrecht BG, Boujoukas AJ, Sirio CA, Farkas LM, Lee KK, Simmons RL. Fulminant Clostridium difficile: an underappreciated and increasing cause of death and complications. Ann Surg 2002;235(3):363–372.PubMedCrossRef

12.

Yassin SF, Young-Fadok TM, Zein NN, Pardi DS. Clostridium difficile-associated diarrhea and colitis. Mayo Clin Proc 2001;76:725–730.PubMedCrossRef

13.

Synnott K, Mealy K, Merry C, Kyne L, Keane C, Quill R. Timing of surgery for fulminating pseudomembranous colitis. Br J Surg 1998;85:229–231.PubMedCrossRef

Title: Long-Term Follow-Up of Patients with Fulminant Clostridium difficile Colitis
Authors: Aaron T. Miller
Parissa Tabrizian
Alexander J. Greenstein
Andrew Dikman
John Byrn
Celia Divino
Publication date: 01-05-2009
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 5/2009
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-009-0819-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Long-Term Follow-Up of Patients with Fulminant Clostridium difficile Colitis

Abstract

Purpose

Material and Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Material and Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 5/2009

Gallstone Formation after Gastric Cancer Surgery

Results of Non-operative Therapy for Delayed Hemorrhage after Pancreaticoduodenectomy

Modified Puestow Lateral Pancreaticojejunostomy

Clinical Remission in Endoscope-Guided Pneumatic Dilation for the Treatment of Esophageal Achalasia: 7-Year Follow-up Results of a Prospective Investigation

Association of Gastroesophageal Reflux and O2 Desaturation: A Novel Study of Simultaneous 24-h MII–pH and Continuous Pulse Oximetry

The Early Use of PET-CT Alters the Management of Patients with Esophageal Cancer