In the Journals

Dialysis, emergency surgery linked to C. difficile infection after colectomy

Factors such as dialysis and low albumin levels before colectomy, as well as requiring emergency surgery, were associated with increased risk for postoperative Clostridium difficile infection in a recent study.

Researchers evaluated incidence of C. difficile infection (CDI) in 4,936 adults within 30 days after colectomies were performed at 23 medical facilities in Michigan. All participants had been enrolled in the Michigan Surgical Quality Collaborative Colectomy Project between March 2008 and March 2011.

“CDI has grown into an increasingly deadly and prevalent infection,” the researchers wrote. “Because surgical patients now carry more than twice the burden of health care-associated infections compared with their medical counterparts, strategies to identify the intrinsic and extrinsic risk factors contributing to avoidable infections are important. … This study represents one of the largest studies of risk factors for CDI in surgical patients using a prospective clinical (not administrative) data set.”

CDI occurred in 1.6% of the cohort, with incidence rates between 0% and 9% at the included facilities. These participants experienced sepsis (P=.001) and required dialysis (P<.0001) and use of a ventilator (P=.012) more frequently than those who did not develop CDI. Emergent (23% vs. 10%) and open surgery (71% vs. 58%) also were more common among infected patients.

Logistic regression analysis indicated that low albumin levels (OR=0.572, 0.393-0.833), dialysis (OR=6.049, 2.104-17.394), emergency surgery (OR=1.862, 1.045-3.317) and a history of transient ischemic attack (OR=2.549, 1.134-5.728) were independently predictive of CDI (95% CI for all). After adjusting for comorbidities and hospital site, no association was observed between incidence of CDI and antibiotics use.

“The burden of risk for CDI may be influenced more by individual patient comorbidities than other device-related health care-associated infections, such as urinary tract and central line-associated infections,” the researchers wrote. “Therefore, surgical patients at high risk for CDI may benefit from early intervention strategies such as the allocation of a private room, pre-emptive isolation, cohorting nursing staff members and/or patients, reinforced education to patients and visitors, and nurse-driven protocols for initiating timely stool specimen collection and processing.”