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Clostridioides difficile Enteritis in Patients Following Total Colectomy-a Rare but Genuine Clinical Entity
Robert J Ulrich1, Jonathan Bott1,2, Hannah Imlay1
1Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.
Open Forum Infectious Diseases
|November 6, 2019
Summary
Clostridioides difficile enteritis (CDE) is a rare condition in post-colectomy patients, often presenting as severe disease requiring hospitalization. Risk factors include acid suppression, inflammatory bowel disease, and specific antibiotic use with enteral feeds.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Surgical Outcomes
Background:
- Clostridioides difficile infection (CDI) commonly causes colitis post-antibiotics.
- C. difficile enteritis (CDE) was previously considered impossible but is now recognized.
- Prevalence, severity, and risk factors for CDE remain largely unknown.
Purpose of the Study:
- To determine the prevalence and severity of CDE in post-colectomy patients.
- To identify potential risk factors associated with CDE development.
Main Methods:
- Retrospective analysis of total colectomy patients over 20 years.
- Defined CDE by clinical symptoms and positive stool tests post-colectomy.
- Used multivariable analysis to compare CDE cases with controls.
Main Results:
- CDE occurred in 5.1% of patients, a median of 130 days post-colectomy.
- Identified risk factors: perioperative acid suppression, colectomy for IBD or CDI, and beta-lactam use with enteral feeds.
- CDE presented as severe disease in 50% of cases, requiring hospitalization in 81.8%.
Conclusions:
- CDE is a rare but significant entity in post-colectomy patients with CDI symptoms.
- Risk factors resemble traditional CDI, including acid suppression and IBD.
- Antibiotic use with enteral feeds may increase CDE risk; CDE often presents severely and requires hospitalization.
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