Prevalence of clostridium difficile in excluded colons

Area of Science:

• Gastroenterology
• Infectious Diseases
• Surgical Outcomes

Background:

• Clostridium difficile infection (CDI) causes significant morbidity, mortality, and healthcare costs.
• CDI has been reported in excluded bowels following defunctioning ileostomy reversal.
• The colonization rate of C. difficile in excluded colons remains unclear.

Purpose of the Study:

• To prospectively investigate the rate of C. difficile colonization in the excluded colon after defunctioning ileostomy reversal.
• To compare this colonization rate to that of the healthy adult population.
• To assess the potential increased risk of CDI in patients with an excluded colon.

Main Methods:

• Prospective recruitment of patients undergoing ileostomy closure.
• Collection of stool samples from ileostomy effluent pre- and post-closure.
• Culture for C. difficile and testing for toxins A and B using EIA.

Main Results:

• Two of 20 subjects (10%) had positive stool cultures for C. difficile postoperatively.
• One patient developed clinical pseudomembranous colitis with positive toxin.
• Estimated colonization rates ranged from 3-38% (95% CI) or 6-44% based on observed cases, exceeding the 3% incidence in healthy adults.

Conclusions:

• The excluded colon may harbor a higher rate of C. difficile colonization compared to the general population.
• This suggests a potential increased risk for C. difficile infection after ileostomy reversal.
• Larger, well-powered studies are warranted to confirm these findings.