Clostridioides difficile Enteritis in Patients Following Total Colectomy-a Rare but Genuine Clinical Entity.

摘要: Objective Clostridioides difficile infection (CDI) frequently causes colitis following antibiotic exposure and is a leading cause of gastrointestinal infectious mortality. Infection in the small bowel, C. enteritis (CDE), was previously thought impossible, but case series have challenged this dogma. prevalence, severity, potential risk factors are unknown. Methods We retrospectively analyzed all total colectomy patients over 20-year period at our institution. defined by clinical symptoms positive stool testing after colectomy. compared CDE cases to controls using multivariable analysis identify factors. Results occurred 44 855 (5.1%) patients, median 130 days Compared controls, were similar age, gender, presence immunosuppression. The majority (64%) had antibiotics <30 prior CDE. In analysis, included perioperative acid suppression (hazard ratio [HR], 2.52; 95% confidence interval [CI], 1.26-5.04; P = .009), for inflammatory bowel disease (HR, 2.95; CI, 1.29-6.72; .010), CDI 9.95; 2.70-36.63; ≤ .001), β-lactam use setting enteral feeds 17.83; 2.75-115.68; .003). presented with severe half time, 81.8% requiring hospitalization. Conclusions rare entity that should be considered postcolectomy presenting symptoms, even years surgery. Like traditional CDI, likely include disease. Prior may amplify risk. often presents as requires