C Difficile Rates High Among Emergency General Surgery Patients

How many days between hospital admission and surgery could play a significant role, investigators noted.

Adrian A. Coleoglou Centeno, MD

Patients who undergo emergency general surgery (EGS) have a high incidence of Clostridium difficile (C difficile) infection, according to a new report.

Researchers from Washington University in St. Louis examined 550 patients with EGS between 2008 and 2015 in order to determine the risk factors for C difficile infection.

“Our idea to look at C difficile infection in EGS was motivated due to the increasing research being done in the EGS area since this is a developing field within the acute and critical care surgery practice,” study author Adrian A. Coleoglou Centeno, MD, told MD Magazine®. “At the beginning when we developed our idea we expected that the patients that developed C difficile infection postoperatively were going to have increased mortality and significantly longer length of stay (LOS).”

The most common procedures these patients underwent were partial colectomies, small bowel resections/repairs, gastric repair for perforated peptic ulcer, skin and soft tissue procedure, and laparotomies, the investigators learned.

Overall, the total C difficile infection incidence was 12.7%, the researchers learned. There did not appear to be any significant differences between the C difficile positive and negative patients within the EGS group. This a considerably high number to consider, the researchers said, as trauma patients have an incidence of about 3%, Centeno said.

There weren’t any differences between the groups among mortality, LOS or intensive care unit LOS; Centeno said that was a particular surprise in the findings.

“The reason for the no difference in the outcomes we attributed it to the high level of comorbidities in the EGS patient population, these patients are very sick on admission and it seems like adding another comorbidity such as C difficile does not have an impact in most of the evolution of the patient in the hospital,” Centeno said.

One emerging trend in the research demonstrated the relationship between the time of getting an operation after hospital admission and the risk for developing C difficile infection. In this analysis, the patients who had a procedure later on their admission (after day 1, for example) had a lower risk for developing C difficile after their operation.

However, the study authors do not advocate for delating surgeries with the intent of decreasing the risk for C difficile infection acquisition. Centeno said that, instead, he and the team believe that their work will help physicians have a greater reason to suspect C difficile in EGS patients. This way, the healthcare industry can develop interventions that reduce the risk for the infection post-surgery.

“Although C difficile infection may not impact patient’s outcomes it does increase the financial burden on the health care system, C difficile infection is one of the conditions monitored by the Center for Medicare and Medicaid Services and institutions that underperform may carry financial penalties for lacking sufficient interventions or strategies to prevent C difficile infection,” Centeno said.

Centeno also wanted to give special acknowledgement to his mentor, Grant V. Bochicchio, MD, who helped develop the idea for this work.

The paper, “Early Emergency General Surgery Is Associated with a Higher Incidence of Clostridium difficile Infection,” was published online in Surgical Infections.