Clostridium difficile infection in patients with ileal pouch-anal anastomosis.

Abstract

BACKGROUND & AIMS:

There has been an increase in the incidence and severity of Clostridium difficile-associated diarrhea in the U.S. The importance of C difficile infection in patients with ileal pouch-anal anastomosis (IPAA) is unknown. This study was designed to determine risk of acquiring C difficile infection in pouch disorders.

METHODS:

Consecutive ulcerative colitis patients (n = 115) with IPAA undergoing pouch endoscopy were enrolled from May 2005-March 2006. Fecal specimens of pouch aspirate were collected during pouch endoscopy and analyzed for C difficile toxin A and B by enzyme-linked immunosorbent assay. Nineteen clinical, endoscopic, and histologic variables were assessed with stepwise selection methods. Two multivariate logistic regression models were constructed.

RESULTS:

Twenty-one patients (18.3%) were positive for C difficile infection. Adjusting for other factors in the model, men were 5.12 (95% confidence interval, 1.38-20.46) times more likely to have C difficile infection than women. Compared with patients with pancolitis, those with preoperative left-sided colitis were 8.4 (95% confidence interval, 1.25-56.4) times more likely to have C difficile infection. Six of 6 patients with C difficile infection (3 with refractory pouchitis, 2 with Crohn's disease, and 1 with irritable pouch syndrome) with repeat clinical, endoscopic, and laboratory evaluation after anti-C difficile therapy experienced clinical remission and disappearance of C difficile toxin from stools, with 4 showing decreased mucosal inflammation.

CONCLUSIONS:

C difficile infection involving IPAA is common, characteristically occurring with or without previous receipt of antibiotics. Treatment of C difficile infection in patients with IPAA might improve the clinical outcome.

• Authors: B O Shen, Zhi-Dong Jiang, Victor W Fazio, Feza H Remzi, Liliana Rodriguez, Ana E Bennett, Rocio Lopez, Elaine Queener, Herbert L Dupont
• Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (Clin Gastroenterol Hepatol) Vol. 6 Issue 7 Pg. 782-8 (Jul 2008) ISSN: 1542-7714 [Electronic] United States
• PMID: 18467184 (Publication Type: Journal Article)

Chemical References

• Bacterial Proteins
• Bacterial Toxins
• Enterotoxins
• tcdA protein, Clostridium difficile
• toxB protein, Clostridium difficile

Topics

• Adult
• Anal Canal
• Anastomosis, Surgical (adverse effects)
• Bacterial Proteins (analysis)
• Bacterial Toxins (analysis)
• Clostridioides difficile (isolation & purification)
• Colitis, Ulcerative (complications, surgery)
• Colonic Pouches
• Diarrhea (microbiology)
• Enterocolitis, Pseudomembranous (diagnosis, epidemiology)
• Enterotoxins (analysis)
• Enzyme-Linked Immunosorbent Assay
• Feces (chemistry)
• Female
• Humans
• Male
• Middle Aged
• Risk Factors
• Sex Factors
• United States