Is Clostridium difficile infection a particular problem after reversal of ileostomy?

AIM: Clostridium difficile infection (CDI) is a cause of morbidity and mortality in hospitals. Various independent risk factors have been identified, including age and antibiotic exposure. This study attempted to determine whether surgery and associated antibiotic use influence the development of CDI. METHOD: A retrospective review of all patients with a diagnosis of CDI diagnosed during admission to a colorectal unit was conducted over a 20-month period. Patient records were cross-referenced with a microbiology database to identify previous episodes of infection and cases of recurrence. RESULTS: There were 38 CDI episodes in 29 patients, including nine with recurrence. In 33, the use of antibiotics prior to the onset of CDI was documented, but in 14 (37%) patients this was limited to perioperative prophylaxis. The incidence of CDI after various procedures was as follows: ileostomy closure (4.2%), right hemicolectomy (2.1%) and anterior resection (1%). CONCLUSION: Ileostomy closure may carry a higher risk of CDI.