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Published on: December 10, 2016
Clostridium difficile: What is the risk?
Esther K Liu1, Janae Preece2, Kristina D Suson2
1Department of Urology, Detroit Medical Center, Harper Professional Building, 4160 John R Suite 1017, Detroit, MI 48201, USA.
Insights
Postoperative Clostridium difficile infections (CDI) are rare in pediatric urologic surgery patients, occurring in only 0.13% of cases. When CDI does occur, it is associated with longer hospital stays and increased readmissions.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Urology
Background:
- Clostridium difficile infections (CDIs) are increasingly prevalent in pediatric populations, with higher risks observed in transplant and bowel surgery patients.
- Renal surgery is associated with a lower risk of CDI, prompting investigation into other surgical specialties like pediatric urology.
Purpose of the Study:
- To investigate the incidence of postoperative CDI in pediatric patients undergoing urologic procedures.
- To identify perioperative factors associated with CDI development in this patient cohort.
Main Methods:
- A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program Pediatric data file (2015-2017).
- Inclusion of patients undergoing pediatric urology or urology procedures, with data points on demographics, surgical details, and perioperative outcomes.
- Statistical analyses (t-tests and chi-square) were used to compare patients with and without CDI.
Main Results:
- Of 27,193 patients, 36 (0.13%) developed CDI. Patients with CDI were more likely to be female and have higher ASA classifications.
- CDI cases were associated with significantly longer operative times (156.1 min vs. 105.2 min) and hospital stays (4.6 days vs. 1.3 days).
- Patients with CDI had higher complication rates (29% vs. 6%) and readmission rates (56% vs. 4%), with vesicoureteral reflux correction and nephrectomy being the most common procedures among CDI cases.
Conclusions:
- Postoperative CDI is uncommon following pediatric urologic procedures.
- Although rare, CDI in this population is linked to adverse outcomes including extended hospital stays, increased readmissions, and higher rates of other complications.
Introduction:
Clostridium difficile infections (CDIs) are rising among pediatric patients in the community and hospital setting. Children undergoing transplants and bowel surgery are at a higher risk, while renal surgery has a lower risk. We hypothesize children undergoing pediatric urologic procedures are uncommonly diagnosed with postoperative CDI.
Objective:
To study CDI in pediatric patients undergoing urologic surgery and identify associated perioperative factors.
Study Design:
The American College of Surgeons National Surgical Quality Improvement Program Pediatric data file was queried for children undergoing surgery with pediatric urology or urology between 2015 and 2017. Data points included patient demographics (age, gender, race, ASA classification), surgery performed, and perioperative outcomes (operative time, admission status, length of stay, complications, readmission, and reoperation). Students T-test and Chi-square analyses were applied to detect differences between those with CDI and those without CDI.
Results:
Of the 27,193 patients undergoing urologic surgery, 36 (0.13%) were diagnosed with CDI. The surgeries are presented in the Summary Figure. Patients with CDI were more likely to be female (50% vs 28%, p = 0.003) than those without. There was no difference in mean age or race. Children with CDI had higher ASA classifications (p < 0.001). Their mean operative times were longer (156.1 ± 19.6 vs 105.2 ± 0.6 min, p < 0.001), as were their mean lengths of stay (4.6 ± 0.8 vs 1.3 ± 0.0 days, p < 0.001). CDI patients were more likely to have other complications (29% vs 6%, p < 0.001). Among patients with CDI, 19.4% experienced concomitant infectious complications. There was no difference in reoperation rate, but more patients with CDI required readmission (56% vs 4%, p < 0.001). A third of children with CDI had undergone vesicoureteral reflux correction, comprising 0.3% of the included procedures. Over 11% of children with CDI had undergone nephrectomy, comprising 1.1% of the included procedures for the highest rate.
Discussion:
CDI are uncommon following pediatric urologic procedures. No patients undergoing inguinal or scrotal cases developed CDI, while only one patient developed CDI after penile surgery. Our study does have several important limitations: we are unable to provide clinical information about the exact diagnoses, CDI risk factors such as antibiotic usage or comorbid conditions, and the number of patients who were tested for CDI.
Conclusion:
While pediatric urologists are unlikely to encounter postoperative CDI, when they occur, they are associated with longer lengths of stay, increased readmission rates, and an increased rate of non-CDI complications.
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