Clostridium difficileInfection Worsens the Prognosis of Ulcerative Colitis

Abstract

BACKGROUND: The impact ofClostridium difficileinfections among ulcerative colitis (UC) patients is well characterized. However, there is little knowledge regarding the association betweenC difficileinfections and postoperative complications among UC patients.OBJECTIVE: To determine whetherC difficileinfection is associated with undergoing an emergent colectomy and experiencing postoperative complications.METHODS: The present population-based case-control study identified UC patients admitted to Calgary Health Zone hospitals for a flare between 2000 and 2009.C difficiletoxin tests ordered in hospital or 90 days before hospital admission were provided by Calgary Laboratory Services (Calgary, Alberta). Hospital records were reviewed to confirm diagnoses and to extract clinical data. Multivariate logistic regression analyses were performed among individuals tested forC difficileto examine the association betweenC difficileinfection and emergent colectomy and diagnosis of any postoperative complications and, secondarily, an infectious postoperative complication. Estimates were presented as adjusted ORs with 95% CIs.RESULTS:C difficilewas tested in 278 (58%) UC patients and 6.1% were positive.C difficileinfection was associated with an increased risk for emergent colectomy (adjusted OR 3.39 [95% CI 1.02 to 11.23]). Additionally, a preoperative diagnosis ofC difficilewas significantly associated with the development of postoperative infectious complications (OR 4.76 [95% CI 1.10 to 20.63]).CONCLUSION:C difficilediagnosis worsened the prognosis of UC by increasing the risk of colectomy and postoperative infectious complications following colectomy. Future studies are needed to explore whether early detection and aggressive management ofC difficileinfection will improve UC outcomes.