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Colectomy Highly Beneficial for Severe Clostridium Difficile Colitis: Presented at ACS
By Crystal Phend
SAN FRANCISCO, CA -- October 20, 2005 -- Severe cases of Clostridium difficile bacterial infection have often been treated by removing the site of infection, the colon, although there has until now been no evidence that this procedure was in fact beneficial.
Now, results of a study show that colectomy significantly improves survival in the worst cases of bacterial infections with C. difficile, researchers reported here on October 18th at the annual meeting of the American College of Surgeons (ACS).
"Surgery should be considered early in the course of severe disease," said lead author and presenter Francois Lamontagne, MD, Internal Medicine Resident, University of Sherbrooke, Sherbrooke, Quebec, Canada.
The worldwide incidence and severity of C. difficile-associated disease is increasing, according to published reports. Dr. Lamontagne said an increasing number of cases at the Sherbrooke Hospital are severe enough to require admission to the intensive care unit.
Dr. Lamontagne and colleagues studied a retrospective observational cohort of 161 patients with C. difficile-associated disease that required admission to the intensive care unit in two hospitals in the province of Quebec between January 2003 and June 2005.
Of those patients, 52.7% died within 30 days of admission and nearly half of those deaths occurred in the first 48 hours.
Patients receiving emergency colectomy were significantly less likely to die than those treated medically. Of the 127 patients treated medically, 58% died compared to 34% of the 38 colectomy patients.
Independent predictors of 30-day mortality included elevated white blood cell count, elevated lactate level, age 75 years or older, immunosupression, and shock requiring vasopressors.
The researchers worked these factors into a new risk assessment scale and treatment algorithm. Patients with high scores based on the number and degree of risk factors receive emergency colectomy while patients with low risk receive medical treatment and daily reassessment. Patients with intermediate scores can be treated surgically or medically based on physician choice, according to the algorithm.
C. difficile bacteria are commonly present in the intestinal tract but typically only cause illness after a course of antibiotics, Dr. Lamontagne said.
[Presentation title: Outbreak of Severe Clostridium Difficile-Associated Colitis with Multiple Organ Failure in Quebec Intensive Care Units: Analysis in Sherbrooke ICUs. Scientific exhibit 106]
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