Clostridium difficile Infection and Colorectal Surgeries: A Narrative Review

Document Type : Review

Authors

Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Clostridium difficile infection (CDI) is a significant health-related infection rarely seen in colorectal patients after surgery. However, over the past two decades, there has been an increase in the incidence and severity of CDI. In addition, the healthcare system is impacted significantly by the morbidity, mortality, and costs associated with CDI. While antibiotic use was initially thought to be the only cause, CDI has now been associated with hospitalization and residence in long-term care facilities. The risk of developing CDI is higher for patients who undergo gastrointestinal procedures, including colectomy. Hence, targeting preventive measures and reducing the burden associated with CDI can be achieved by identifying colorectal surgery patients at high risk for this increasingly prevalent disease. In the present article, we aim to review the current evidence of pre- and postoperative CDI in patients with underlying colorectal surgeries due to benign or malignant conditions, pointing to risk factors for infection, clinical impact, and outcomes.

Keywords

References

  1. Asha N, Tompkins D, Wilcox M. Comparative analysis of prevalence, risk factors, and molecular epidemiology of antibiotic-associated diarrhea due to Clostridium difficile, Clostridium perfringens, and Staphylococcus aureus. Journal of clinical microbiology.2006;44(8):2785-91.PMid:16891493
  2. Sartelli M, Malangoni MA, Abu-Zidan FM, Griffiths EA, Di Bella S, McFarland LV, et al. WSES guidelines for management of Clostridium difficile infection in surgical patients. World Journal of Emergency Surgery. 2015;10(1):1-23.PMid:26300956 PMCid:PMC4545872
  3. Zerey M, Paton BL, Lincourt AE, Gersin KS, Kercher KW, Heniford BT. The burden of Clostridium difficile in surgical patients in the United States. Surgical infections. 2007;8(6):557-66.PMid:18171114
  4. Brown E, Talbot GH, Axelrod P, Provencher M, Hoegg C. Risk factors for Clostridium difficile toxin-associated diarrhea. Infection Control & Hospital Epidemiology. 1990;11(6):283-90.PMid:2373850
  5. Krapohl GL, Morris AM, Cai S, Englesbe MJ, Aronoff DM, Campbell Jr DA, et al. Preoperative risk factors for postoperative Clostridium difficile infection in colectomy patients. The American Journal of Surgery.2013;205(3):343-8. PMid:23375705 PMCid:PMC4119815
  6. Theriot CM, Young VB. Microbial and metabolic interactions between the gastrointestinal tract and Clostridium difficile infection. Gut microbes. 2014;5(1):86-95.PMid:24335555 PMCid:PMC4049944
  7. Fekety R, Shah AB. Diagnosis and treatment of Clostridium difficile colitis. Jama. 1993;269(1):71-5.PMid:8416409
  8. Lesperance K, Causey MW, Spencer M, Steele SR. The morbidity of Clostridium difficile infection after elective colonic resection-results from a national population database. The American Journal of Surgery.2011;201(2):141-8. PMid:21266214
  9. Southern WN, Rahmani R, Aroniadis O, Khorshidi I, Thanjan A, Ibrahim C, et al. Postoperative Clostridium difficile-associated diarrhea.Surgery.2010;148(1):24-30.PMid:20116817
  10. Bagdasarian N, Rao K, Malani PN. Diagnosis and treatment of Clostridium difficile in adults: a systematic review. Jama. 2015;313(4):398-408.PMid:25626036 PMCid:PMC6561347
  11. Tirelli F, Lorenzon L, Biondi A, Langellotti L, Santoro G, Agnes A, et al. Predictors of Clostridium difficile infection after stoma reversal following TaTME surgery. Updates in Surgery. 2023;75(6):1589-96.PMid:37540407 PMCid:PMC10435656
  12. Kent KC, Rubin MS, Wroblewski L, Hanff PA, Silen W. The impact of Clostridium difficile on a surgical service: a prospective study of 374 patients. Annals of surgery. 1998;227(2):296.PMid:9488530 PMCid:PMC1191249
  13. Yeom CH, Cho MM, Baek SK, Bae OS. Risk factors for the development of Clostridium difficile-associated colitis after colorectal cancer surgery. Journal of the Korean Society of Coloproctology.2010;26(5):329.PMid:21152135
  14. Harries R, Ansell J, Codd R, Williams G. A systematic review of Clostridium difficile infection following reversal of ileostomy. Colorectal Disease. 2017;19(10):881-7.PMid:28872758
  15. Groner JI, Edmiston CE, Krepel CJ, Telford GL, Condon RE. The efficacy of oral antimicrobials in reducing aerobic and anaerobic colonic mucosal flora. Archives of Surgery. 1989;124(3):281-4. PMid:2919961
  16. Damle RN, Cherng NB, Flahive JM, Davids JS, Maykel JA, Sturrock PR, et al. Clostridium difficile infection after colorectal surgery: a rare but costly complication. Journal of Gastrointestinal Surgery. 2014;18:1804-11.doi:doi.org/10.1007/s11605-014-2600-7 PMid:25091840
  17. Kamboj M, Son C, Cantu S, Chemaly RF, Dickman J, Dubberke E, et al. Hospital-onset Clostridium difficile infection rates in persons with cancer or hematopoietic stem cell transplant: a C3IC network report. Infection Control & Hospital Epidemiology. 2012;33(11):1162-5. doi:https://doi.org/10.1086/668023 PMid:23041818
  18. Rubin MS, Bodenstein LE, Kent KC. Severe Clostridium difficile colitis. Diseases of the colon & rectum. 1995;38:350-4.
    doi:https://doi.org/10.1007/BF02054220 PMid:7720439
  19. Sobhani I, Tap J, Roudot-Thoraval F, Roperch JP, Letulle S, Langella P, et al. Microbial dysbiosis in colorectal cancer (CRC) patients. PloS one. 2011;6(1):e16393.doi:https://doi.org/10.1371/journal.pone.0016393 PMid:21297998 PMCid:PMC3029306
  20. Amiot A, Mansour H, Baumgaertner I, Delchier J-C, Tournigand C, Furet J-P, et al. The detection of the methylated Wif-1 gene is more accurate than a fecal occult blood test for colorectal cancer screening. PLoS One. 2014;9(7):e99233.doi:https://doi.org/10.1371/journal.pone.0099233 PMid:25025467 PMCid:PMC4099003
  21. Yasunaga H, Horiguchi H, Hashimoto H, Matsuda S, Fushimi K. The burden of Clostridium difficile-associated disease following digestive tract surgery in Japan. Journal of Hospital Infection. 2012;82(3):175-80. doi:https://doi.org/10.1016/j.jhin.2012.07.023 PMid:23021129
  22. Hebbard AI, Slavin MA, Reed C, Trubiano JA, Teh BW, Haeusler GM, et al. Risks factors and outcomes of Clostridium difficile infection in patients with cancer: a matched case-control study. Supportive Care in Cancer. 2017;25:1923-30. doi:https://doi.org/10.1007/s00520-017-3606-y PMid:28155020
  23. Gaertner WB, Madoff RD, Mellgren A, Kwaan MR, Melton GB. Postoperative diarrhea and high ostomy output impact postoperative outcomes after elective colon and rectal operations regardless of Clostridium difficile infection. The American Journal of Surgery.2015;210(4):759-65.
    doi:https://doi.org/10.1016/j.amjsurg.2015.03.032 PMid:26117432
  24. Zheng Y, Luo Y, Lv Y, Huang C, Sheng Q, Zhao P, et al. Clostridium difficile colonization in preoperative colorectal cancer patients. Oncotarget. 2017;8(7):11877. doi:https://doi.org/10.18632/oncotarget.14424 PMid:28060753 PMCid:PMC5355311
  25. Lightner AL, Tse CS, Quinn K, Bergquist JR, Enders F, Pendegraft R, et al. Preoperative Clostridium difficile Infection Does Not Affect Pouch Outcomes in Patients with Ulcerative Colitis Who Undergo Ileal Pouch-anal Anastomosis. Inflamm Bowel Dis. 2017;23(7):1195-201.
    doi:https://doi.org/10.1097/MIB.0000000000001122 PMid:28410344
  26. Ferrante M, Declerck S, De Hertogh G, Van Assche G, Geboes K, Rutgeerts P, et al. Outcome after proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis. Inflammatory bowel diseases.2008;14(1):20-8. doi:https://doi.org/10.1002/ibd.20278 PMid:17973304
  27. Boeriu A, Roman A, Fofiu C, Dobru D. The current knowledge on Clostridioides difficile infection in patients with inflammatory bowel diseases. Pathogens. 2022;11(7):819. doi:https://doi.org/10.3390/pathogens11070819 PMid:35890064 PMCid:PMC9323231
  28. Li Y, Qian J, Queener E, Shen B. Risk factors and outcome of PCR-detected Clostridium difficile infection in ileal pouch patients. Inflammatory bowel diseases. 2013;19(2):397-403. doi:https://doi.org/10.1097/MIB.0b013e318280fcb9 PMid:23328770
  29. Shen B, Jiang ZD, Fazio VW, Remzi FH, Rodriguez L, Bennett AE, et al. Clostridium difficile infection in patients with ileal pouch-anal anastomosis. Clinical Gastroenterology and Hepatology. 2008;6(7):782-8. doi:https://doi.org/10.1016/j.cgh.2008.02.021 PMid:18467184
  30. Goodhand JR, Alazawi W, Rampton DS. Systematic review: Clostridium difficile and inflammatory bowel disease. Alimentary pharmacology & therapeutics. 2011;33(4):428-41. doi:https://doi.org/10.1111/j.1365-2036.2010.04548.x PMid:21198703
  31. Shen B, Remzi FH, Fazio VW. Fulminant Clostridium difficile-associated pouchitis with a fatal outcome. Nature reviews Gastroenterology & hepatology. 2009;6(8):492-5. doi:https://doi.org/10.1038/nrgastro.2009.105 PMid:19654602
  32. Sun C, Du P, Wu X-r, Queener E, Shen B. Preoperative Clostridium difficile infection is not associated with an increased risk for the infection in ileal pouch patients. Digestive Diseases and Sciences. 2014;59:1262-8. doi:https://doi.org/10.1007/s10620-014-3047-0 PMid:24504594
  33. Skowron KB, Lapin B, Rubin M, Hurst RD, Rubin DT, Hyman NH, et al. Clostridium difficile infection in ulcerative colitis: can alteration of the gut-associated microbiome contribute to pouch failure? Inflammatory bowel diseases. 2016;22(4):902-11.
    doi:https://doi.org/10.1097/MIB.0000000000000710PMid:26891259
  34. Shore BM, Weaver KN, Allegretti JR, Herfarth HH, Barnes EL. Prevalence of Clostridioides difficile Infection After Ileal Pouch-anal Anastomosis in Patients With Chronic Antibiotic-dependent Pouchitis and Crohn's-like Disease of the Pouch. Inflammatory Bowel Diseases. 2023;29(6):932-7.
    doi:https://doi.org/10.1093/ibd/izac165 PMid:35905034 PMCid:PMC10233392
  35. Martinez Ugarte M, Lightner A, Colibaseanu D, Khanna S, Pardi D, Dozois E, et al. Clostridium difficile infection after restorative proctocolectomy and ileal pouch anal anastomosis for ulcerative colitis. Colorectal Disease. 2016;18(5):O154-O7.
    doi:https://doi.org/10.1111/codi.13325 PMid:26945555
  36. Razik R, Rumman A, Bahreini Z, McGeer A, Nguyen GC. Recurrence of Clostridium difficile infection in patients with inflammatory bowel disease: the RECIDIVISM study. Official journal of the American College of Gastroenterology| ACG. 2016;111(8):1141-6.
    doi:https://doi.org/10.1038/ajg.2016.187
  37. Seril DN, Ashburn JH, Lian L, Shen B. Risk factors and management of refractory or recurrent clostridium difficile infection in ileal pouch patients. Inflammatory Bowel Diseases. 2014;20(12):2226-33. doi:https://doi.org/10.1097/MIB.0000000000000205 PMid:25222656
  38. Parks T. Natural history of diverticular disease of the colon. Clinics in gastroenterology. 1975;4(1):53-69.
    doi:https://doi.org/10.1016/S0300-5089(21)00097-3 PMid:1109820
  39. Buchner AM, Sonnenberg A. Medical diagnoses and procedures associated with Clostridium difficile colitis. The American journal of gastroenterology. 2001;96(3):766-72. doi:https://doi.org/10.1111/j.1572-0241.2001.03619.x PMid:11280548
  40. Messick CA, Manilich E, Sun C, Hammel JP, Costedio MM. Risk factors and incidence of Clostridium difficile infection after colorectal surgery. Journal of the American College of Surgeons. 2013;217(3):S26-S7. doi:https://doi.org/10.1016/j.jamcollsurg.2013.07.045
  41. Abdalla AO, Narala SB, Abdallah MA, Doshi R, Gullapalli N. The outcomes of Clostridioides difficile infection in patients with diverticular disease: a nationwide analysis. Scandinavian Journal of Gastroenterology.2019;54(11):1353-6.
    doi:https://doi.org/10.1080/00365521.2019.1683223 PMid:31663792
  42. Feuerstadt P, Das R, Brandt LJ. Diverticular disease of the colon does not increase risk of repeat C. difficile infection. Journal of clinical gastroenterology. 2013;47(5):426-31. doi:https://doi.org/10.1097/MCG.0b013e318276beea PMid:23442832
  43. Randall J, Young B, Patel G, Fitzgerald A, George B. Is Clostridium difficile infection a particular problem after reversal of ileostomy? Colorectal Disease. 2011;13(3):308-11. doi:https://doi.org/10.1111/j.1463-1318.2009.02139.x PMid:19925492
  44. Skancke M, Vaziri K, Umapathi B, Amdur R, Radomski M, Obias V. Elective stoma reversal has a higher incidence of postoperative Clostridium difficile infection compared with elective colectomy: an analysis using the American College of Surgeons National Surgical Quality Improvement Program and targeted colectomy databases. Diseases of the Colon & Rectum. 2018;61(5):593-8. doi:https://doi.org/10.1097/DCR.0000000000001041 PMid:29578918
  45. Zacharioudakis IM, Zervou FN, Pliakos EE, Ziakas PD, Mylonakis E. Colonization with toxinogenic C. difficile upon hospital admission, and risk of infection: a systematic review and meta-analysis. Official journal of the American College of Gastroenterology| ACG. 2015;110(3):381-90.
    doi:https://doi.org/10.1038/ajg.2015.22
  46. Kim YI, Yu CS, Kim YS, Kim CW, Lee JL, Yoon YS, et al. Clostridium difficile infection after ileostomy closure and anastomotic failure in rectal cancer surgery patients. BJS open. 2022;6(2):zrac026. doi:https://doi.org/10.1093/bjsopen/zrac026 PMid:35445239 PMCid:PMC9021405
  47. Rubio-Perez I, Leon M, Pastor D, Dominguez JD, Cantero R. Increased postoperative complications after protective ileostomy closure delay: an institutional study. World journal of gastrointestinal surgery. 2014;6(9):169. doi:https://doi.org/10.4240/wjgs.v6.i9.169 PMid:25276286
  48. Wren SM, Ahmed N, Jamal A, Safadi BY. Preoperative oral antibiotics in colorectal surgery increase the rate of Clostridium difficile colitis. Archives of surgery. 2005;140(8):752-6.doi:https://doi.org/10.1001/archsurg.140.8.752PMid:16103284
  49. Dial S, Alrasadi K, Manoukian C, Huang A, Menzies D. Risk of Clostridium difficile diarrhea among hospital inpatients prescribed proton pump inhibitors: cohort and case-control studies. Cmaj. 2004;171(1):33-8.doi:https://doi.org/10.1503/cmaj.1040876PMid:15238493 PMCid:PMC437681
  50. Wenisch JM, Schmid D, Kuo H-W, Allerberger F, Michl V, Tesik P, et al. Prospective observational study comparing three different treatment regimes in patients with Clostridium difficile infection. Antimicrobial agents and chemotherapy. 2012;56(4):1974-8.
    doi:https://doi.org/10.1128/AAC.05647-11 PMid:22252830 PMCid:PMC3318337
  51. Fernandes R, Robinson P, Rangarajan K, Scott S, Angco L. The role of single-shot metronidazole in the prevention of Clostridium difficile infection following ileostomy reversal surgery. International journal of colorectal disease. 2017;32:733-6.
    doi:https://doi.org/10.1007/s00384-016-2725-0 PMid:27878620
  52. Cooper CC, Jump RL, Chopra T. Prevention of infection due to Clostridium difficile. Infectious Disease Clinics. 2016;30(4):999-1012.
    doi:https://doi.org/10.1016/j.idc.2016.07.005 PMid:27660089
  53. Stevens V, Dumyati G, Fine LS, Fisher SG, van Wijngaarden E. Cumulative antibiotic exposures over time and the risk of Clostridium difficile infection. Clinical infectious diseases. 2011;53(1):42-8. doi:https://doi.org/10.1093/cid/cir301PMid:21653301
  54. Khorasani S, Dossa F, McKechnie T, Englesakis M, Brar MS, van Overstraeten AdB. Association between preoperative oral antibiotics and the incidence of postoperative Clostridium difficile infection in adults undergoing elective colorectal resection: a systematic review and meta-analysis. Diseases of the Colon & Rectum. 2020;63(4):545-61. doi:https://doi.org/10.1097/DCR.0000000000001619 PMid:32101994

 

Reviews in Clinical Medicine
Volume 11, Issue 4
December 2024
Pages 10-14

Files

Share

How to cite

Statistics