Delayed ileostomy closure increases the odds of Clostridium difficile infection.
clostridium difficile
ileostomy
stoma
Journal
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland
ISSN: 1463-1318
Titre abrégé: Colorectal Dis
Pays: England
ID NLM: 100883611
Informations de publication
Date de publication:
12 2021
12 2021
Historique:
revised:
30
06
2021
received:
16
04
2021
accepted:
31
07
2021
pubmed:
6
8
2021
medline:
29
1
2022
entrez:
5
8
2021
Statut:
ppublish
Résumé
A diverting ileostomy is typically performed to divert intestinal contents in high-risk colorectal anastomoses. Ileostomy closure is associated with high rates of postoperative Clostridium difficile infection (CDI). Risk factors for the development of CDI are unclear; however, a correlation has been observed with delayed closure. This study aimed to assess the odds of developing CDI in patients who had a delay to reversal of ileostomy, compared to those who had no delay. A retrospective cohort study was conducted of patients undergoing reversal of ileostomy between 2010 and 2019 at a single tertiary centre. A delay to reversal of ileostomy was defined if the procedure was performed at >365 days following the index procedure. CDI was defined as the presence of Clostridium difficile toxin associated with diarrhoea. Univariable logistic regression analysis was performed to estimate odds of CDI for each covariable, comparing patients who had a delay to reversal of ileostomy with those who did not. Multivariable logistic regression analysis was used to adjust for the potential confounding effects of covariables. Of 195 patients, 11 (5.6%), developed postoperative CDI. Multivariable analysis showed that delay to reversal of ileostomy was associated with a nearly 7-fold increase in odds of CDI (OR = 6.95, CI: 1.06-81.6; p-value = 0.03). A delay to reversal of ileostomy of >365 days was associated with a higher incidence of CDI postoperatively. Careful consideration should be given to the timing of reversal and appropriate preoperative counselling of patients.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3213-3219Informations de copyright
© 2021 The Association of Coloproctology of Great Britain and Ireland.
Références
Sartelli M, Di Bella S, McFarland LV, Khanna S, Furuya-Kanamori L, Abuzeid N, et al. 2019 update of the WSES guidelines for management of Clostridioides (Clostridium) difficile infection in surgical patients. World J Emerg Surg. 2019;14:8.
Depestel DD, Aronoff DM. Epidemiology of Clostridium difficile infection. J Pharm Pract. 2013;26(5):464-75.
Valiente E, Dawson LF, Cairns MD, Stabler RA, Wren BW. Emergence of new PCR ribotypes from the hypervirulent Clostridium difficile 027 lineage. J Med Microbiol. 2012;61(Pt 1):49-56.
McGlone SM, Bailey RR, Zimmer SM, Popovich MJ, Tian Y, Ufberg P, et al. The economic burden of Clostridium difficile. Clin Microbiol Infect. 2012;18(3):282-9.
Randall JK, Young BC, Patel G, Fitzgerald A, George BD. Is Clostridium difficile infection a particular problem after reversal of ileostomy? Colorectal Dis. 2011;13(3):308-11.
Fernandes R, Robinson P, Rangarajan K, Scott S, Angco L. The role of single-shot metronidazole in the prevention of Clostridium difficile infection following ileostomy reversal surgery. Int J Colorectal Dis. 2017;32(5):733-6.
Harries RL, Ansell J, Codd RJ, Williams GL. A systematic review of Clostridium difficile infection following reversal of ileostomy. Colorectal Dis. 2017;19(10):881-7.
Wilson MZ, Hollenbeak CS, Stewart DB. Impact of Clostridium difficile colitis following closure of a diverting loop ileostomy: results of a matched cohort study. Colorectal Dis. 2013;15(8):974-81.
Leffler DA, Lamont JT. Clostridium difficile infection. N Engl J Med. 2015;372(16):1539-48.
Bax TW, McNevin MS. The value of diverting loop ileostomy on the high-risk colon and rectal anastomosis. Am J Surg. 2007;193(5):585-7.
Waterland P, Goonetilleke K, Naumann DN, Sutcliff M, Soliman F. Defunctioning ileostomy reversal rates and reasons for delayed reversal: does delay impact on complications of ileostomy reversal? A study of 170 defunctioning ileostomies. J Clin Med Res. 2015;7(9):685-9.
National Bowel Cancer Audit Project Version. 2; 2019. https://www.nboca.org.uk/reports/annual-report-2019/. Accessed 14 Oct 2020.
Chow A, Tilney HS, Paraskeva P, Jeyarajah S, Zacharakis E, Purkayastha S. The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases. Int J Colorectal Dis. 2009;24(6):711-23.
Rubio-Perez I, Leon M, Pastor D, Diaz Dominguez J, Cantero R. Increased postoperative complications after protective ileostomy closure delay: an institutional study. World J Gastrointest Surg. 2014;6(9):169-74.
Eze P, Balsells E, Kyaw MH, Nair H. Risk factors for Clostridium difficile infections - an overview of the evidence base and challenges in data synthesis. J Glob Health. 2017;7(1):10417.
Guh AY, Mu Y, Winston LG, Johnston H, Olson D, Farley MM, et al. Trends in U.S. burden of Clostridioides difficile infection and outcomes. N Engl J Med. 2020;382(14):1320-30.
Abe I, Kawamura YJ, Sasaki J, Konishi F. Acute fulminant pseudomembranous colitis which developed after ileostomy closure and required emergent total colectomy: a case report. J Med Case Rep. 2012;6:130.
Fashandi AZ, Ellis SR, Smith PW, Hallowell PT. Overwhelming recurrent Clostridium difficile infection after reversal of diverting loop ileostomy created for prior fulminant C. difficile colitis. Am Surg. 2016;82(8):e194-5.
Loo VG, Bourgault A-M, Poirier L, Lamothe F, Michaud S, Turgeon N, et al. Host and pathogen factors for Clostridium difficile infection and colonization. N Engl J Med. 2011;365(18):1693-703.
Choi YJ, Kwak J-M, Ha N, Lee TH, Baek SJ, Kim J, et al. Clinical outcomes of ileostomy closure according to timing during adjuvant chemotherapy after rectal cancer surgery. Ann Coloproctol. 2019;35(4):187-93.
Danielsen AK, Park J, Jansen JE, Bock D, Skullman S, Wedin A, et al. Early closure of a temporary ileostomy in patients with rectal cancer: a multicenter randomized controlled trial. Ann Surg. 2017;265(2):284-90.