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1.
Medicina (Kaunas) ; 59(5)2023 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-37241061

RESUMO

Background and Objectives: Colitis with Clostridium difficile is an important health problem that occurs with an intensity that varies between mild and severe. Surgical interventions are required only in fulminant forms. There is little evidence regarding the best surgical intervention in these cases. Materials and Methods: Patients with C. difficile infection were identified from the two surgery clinics from the 'Saint Spiridon' Emergency Hospital Iași, Romania. Data regarding the presentation, indication for surgery, antibiotic therapy, type of toxins, and post-operative outcomes were collected over a 3-year period. Results: From a total of 12,432 patients admitted for emergency or elective surgery, 140 (1.12%) were diagnosed with C. difficile infection. The mortality rate was 14% (20 cases). Non-survivors had higher rates of lower-limb amputations, bowel resections, hepatectomy, and splenectomy. Additional surgery was necessary in 2.8% of cases because of the complications of C. difficile colitis. In three cases, terminal colostomy was performed and as well as one case with subtotal colectomy with ileostomy. All patients who required the second surgery died within the 30-day mortality period. Conclusions: In our prospective study, the incidence was increased both in cases of patients with interventions on the colon and in those requiring limb amputations. Surgical interventions are rarely required in patients with C. difficile colitis.


Assuntos
Clostridioides difficile , Infecções por Clostridium , Colite , Enterocolite Pseudomembranosa , Humanos , Estudos Prospectivos , Romênia/epidemiologia , Estudos Retrospectivos , Infecções por Clostridium/epidemiologia , Infecções por Clostridium/cirurgia , Infecções por Clostridium/diagnóstico , Enterocolite Pseudomembranosa/epidemiologia , Enterocolite Pseudomembranosa/cirurgia , Enterocolite Pseudomembranosa/complicações , Colite/complicações , Colite/cirurgia
2.
J Gastrointest Surg ; 27(7): 1412-1422, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-37081220

RESUMO

BACKGROUND: When surgery is indicated for fulminant Clostridioides difficile infection (CDI), total abdominal colectomy (TAC) is the most common approach. Diverting loop ileostomy (DLI) with antegrade colonic lavage has been introduced as a colon-sparing surgical approach. Prior analyses of National Inpatient Sample (NIS) data suggested equivalent postoperative outcomes between groups but did not evaluate healthcare resource utilization. As such, we aimed to analyze a more recent NIS cohort to compare these two approaches in terms of both postoperative outcomes and healthcare resource utilization. METHODS: A retrospective analysis of the NIS from 2016 to 2019 was conducted. The primary outcome was postoperative in-hospital morbidity. Secondary outcomes included postoperative in-hospital mortality, system-specific postoperative complications, total admission cost, and length of stay (LOS). Univariable and multivariable regressions were utilized to compare the two operative approaches. RESULTS: In total, 886 patients underwent TAC and 409 patients underwent DLI with antegrade colonic lavage. Adjusted analyses demonstrated no difference between groups in postoperative in-hospital morbidity (aOR 0.96, 95%CI 0.64-1.44, p = 0.851) or in-hospital mortality (aOR 1.15, 95%CI 0.81-1.64, p = 0.436). Patients undergoing TAC experienced significantly decreased total admission cost (MD $79,715.34, 95%CI 133,841-25,588, p = 0.004) and shorter postoperative LOS (MD 4.06 days, 95%CI 6.96-1.15, p = 0.006). CONCLUSIONS: There are minimal differences between TAC and DLI with antegrade colonic lavage for fulminant CDI in terms of postoperative morbidity and mortality. Healthcare resource utilization, however, is significantly improved when patients undergo TAC as evidenced by clinically important decreases in total admission cost and postoperative LOS.


Assuntos
Infecções por Clostridium , Colite , Humanos , Clostridioides , Pacientes Internados , Ileostomia , Irrigação Terapêutica , Estudos Retrospectivos , Colectomia , Colite/cirurgia , Infecções por Clostridium/cirurgia , Complicações Pós-Operatórias/cirurgia
3.
Can J Urol ; 29(3): 11170-11174, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35691039

RESUMO

INTRODUCTION: Patients undergoing cystectomy for bladder cancer are at an increased risk for Clostridium difficile infection (CDI) due to prolonged antibiotics and underlying comorbidities. We aim to evaluate CDI risk factors in cystectomy patients. MATERIALS AND METHODS: Utilizing National Surgical Quality Improvement Program (NSQIP), patients undergoing cystectomy with diagnosis of bladder cancer between 2015-2017 were included. Baseline demographics including age, sex, comorbidities, and preoperative labs were collected. Univariate and multivariable logistic regression were used to evaluate risk factors for and complications of CDI during the index hospitalization. RESULTS: There were a total of 6,432 patients included in the analysis, with 6,242 (96%) and 190 (4%) in the non-CDI vs. CDI groups, respectively. Patients with a diagnosis of postoperative CDI were more likely to be female [4.09% vs. 2.71%, p = 0.001] and have lower preoperative albumin [3.78 g/dL (0.52) vs. 3.92 g/dL (0.48), p = 0.003]. Patients with a history of female sex (OR 1.46, p = 0.03), neobladder (OR 1.57, p = 0.01), and low preoperative albumin (OR 1.45, p = 0.04) were at the highest risk for development of CDI postoperatively. Patients with a diagnosis of CDI were more likely to experience readmission within 30 days (31.1% vs. 19.2%, p < 0.001). CONCLUSION: Utilizing the NSQIP database, we identified predictors for development of CDI in cystectomy patients. Female sex, continent diversion, and low preoperative albumin all significantly increased the rate of CDI. While our findings are retrospective, they are compelling enough to warrant further prospective investigation.


Assuntos
Infecções por Clostridium , Neoplasias da Bexiga Urinária , Albuminas , Infecções por Clostridium/epidemiologia , Infecções por Clostridium/etiologia , Infecções por Clostridium/cirurgia , Cistectomia/efeitos adversos , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Melhoria de Qualidade , Estudos Retrospectivos , Fatores de Risco , Neoplasias da Bexiga Urinária/cirurgia
4.
Handchir Mikrochir Plast Chir ; 54(2): 155-159, 2022 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-35419785

RESUMO

We present the case of a 57-year-old male patient with a fatal outcome after resection of a soft tissue sarcoma of the lateral thigh. A polymicrobial surgical site infection with Staphylococcus lugdunensis and Clostridium perfringens caused fulminant necrotising fasciitis with an additional gas gangrene. The patient suffered a severe sepsis with consecutive haemolysis and multiorgan failure. The authors recapitulate the deadly progress of a rarely reported complication after oncological resection. The therapeutic approach and surgical interventions are discussed based on the current literature.


Assuntos
Infecções por Clostridium , Fasciite Necrosante , Gangrena Gasosa , Sarcoma , Neoplasias de Tecidos Moles , Infecções por Clostridium/complicações , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/cirurgia , Fasciite Necrosante/diagnóstico , Fasciite Necrosante/etiologia , Fasciite Necrosante/cirurgia , Evolução Fatal , Gangrena Gasosa/diagnóstico por imagem , Gangrena Gasosa/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Sarcoma/cirurgia , Coxa da Perna/cirurgia
5.
BMC Infect Dis ; 21(1): 462, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34020604

RESUMO

BACKGROUND: Clostridioides difficile usually causes intestinal infections. However, a 75-year-old lady had a periprosthetic joint infection due to this microorganism. We report a C. difficile infection of a prosthetic hip joint. Such an infection is rarely reported around the world. CASE PRESENTATION: The elder female patient presented with a 2-year history of right hip pain with movement restriction. Her right leg was shorter than another. The skin around the right hip joint was red and swollen without sinus. Her lab test result showed elevator ESR and CRP. Her X-ray film showed a massive bone defect. The patient had a total hip arthroplasty 16 years ago and had a revision 5 years ago. During this hospitalization, her cultures of the synovial fluid and tissue repeatedly grew C. difficile. She improved following two-stage revision surgery and antibiotic treatment. The patient has no recurrence of infection after a one-year follow-up. CONCLUSION: A rapid and accurate sample collection is significant for culture results, making an outstanding contribution to the successful treatment.


Assuntos
Artroplastia de Quadril/efeitos adversos , Clostridioides difficile/isolamento & purificação , Infecções por Clostridium , Infecções Relacionadas à Prótese , Reoperação/efeitos adversos , Adolescente , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , China , Clostridioides difficile/genética , Infecções por Clostridium/tratamento farmacológico , Infecções por Clostridium/microbiologia , Infecções por Clostridium/cirurgia , Feminino , Articulação do Quadril/microbiologia , Articulação do Quadril/cirurgia , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/cirurgia , Líquido Sinovial/microbiologia , Resultado do Tratamento
7.
Dis Colon Rectum ; 63(9): 1317-1326, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-33044807

RESUMO

BACKGROUND: Emergency surgery is often required for fulminant Clostridium difficile colitis. Total abdominal colectomy has been the treatment of choice despite high morbidity and mortality. OBJECTIVE: The aim of this meta-analysis was to evaluate postoperative mortality and morbidity after total abdominal colectomy and loop ileostomy with colonic lavage in patients with fulminant C difficile colitis. DATA SOURCES: Studies comparing total abdominal colectomy to loop ileostomy for fulminant C difficile colitis were identified by a systematic search of PubMed, Cochrane Library, MEDLINE, and CINAHL. STUDY SELECTION: Relevant records were detected and screened using a cascade system (title, abstract, and/or full text article). INTERVENTION(S): Total abdominal colectomy (rectal-sparing resection of the entire colon with end ileostomy) was compared to loop ileostomy (exteriorization of an ileal loop not far from the ileocecal junction for colonic lavage). MAIN OUTCOMES MEASURES: This meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines. Primary outcome was postoperative mortality, defined as death occurring within 30 days after the intervention. Secondary end points were the rates of ostomy reversal, deep venous thrombosis/embolism, surgical site infection, urinary tract infection, respiratory complications, reoperations, and adverse events. Mantel-Haenszel method with random-effects model was used for meta-analysis. RESULTS: Five observational studies (3 cohort and 2 database analysis studies) totaling 3683 patients were included. Postoperative mortality rate was 31.3% after total abdominal colectomy and 26.2% after loop ileostomy (OR = 1.36 (95% CI, 0.83-2.24); p = 0.22; number needed to treat/harm = 20; I = 55%). Ostomy reversal rate was both statistically and clinically significantly higher after loop ileostomy as compared with total abdominal colectomy (80% vs 25%; OR = 0.08 (95% CI, 0.02-0.30); p = 0.002; number needed to treat/harm = 2) with low heterogeneity (I = 0%). LIMITATIONS: A limitation is the observational nature of the included studies introducing an overall high risk of selection bias. CONCLUSIONS: This meta-analysis suggests that loop ileostomy with colonic lavage for fulminant C difficile colitis may be associated with similar survival and decreased surgical site infection rates as compared with total abdominal colectomy. Although loop ileostomy with colonic lavage was associated with higher ostomy reversal rates, this finding was based on the data from only 2 studies.


Assuntos
Colectomia/métodos , Colite/cirurgia , Enterocolite Pseudomembranosa/cirurgia , Ileostomia/métodos , Mortalidade , Complicações Pós-Operatórias/epidemiologia , Irrigação Terapêutica/métodos , Infecções por Clostridium/cirurgia , Progressão da Doença , Embolia/epidemiologia , Emergências , Humanos , Pneumonia/epidemiologia , Reoperação/estatística & dados numéricos , Índice de Gravidade de Doença , Infecção da Ferida Cirúrgica/epidemiologia , Infecções Urinárias/epidemiologia , Trombose Venosa/epidemiologia
8.
Vet Ophthalmol ; 23(4): 754-759, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32468722

RESUMO

OBJECTIVE: To present the results of clinical, surgical, and histopathologic procedures and how these were compared with the initial presumptive clinical diagnosis in a corn snake (Pantherophis guttatus) presenting with subspectacular fluid opacity; and to improve upon currently established surgical enucleation techniques in the snake. ANIMAL STUDIED: An 8-month-old corn snake was presented for enlarged globe OD. PROCEDURES: The following diagnostics were performed: systemic and ophthalmic examinations, complete blood count, cytology and culture of subspectacular fluid, and histopathology of enucleated globe and spectacle. Enucleation was performed in a routine fashion with the addition of a porcine small intestinal submucosa bioscaffold graft (SISplus™; Avalon Medical, Stillwater, MN), sutured over the orbit. RESULTS: Systemic examination revealed signs of maxillary stomatitis. Ophthalmic examination revealed semitransparent fluid in the subspectacular space. Complete blood count was unremarkable. Cytology of fluid obtained via subspectacular centesis was acellular, and culture grew Clostridium perfringens, which was consistent with the clinical suspicion of right maxillary stomatitis. Histopathology of the enucleated globe revealed spectaculitis, characterized by regional heterophilic inflammation, and no evidence of lymph dissection in the (peri)ocular tissues. The final diagnosis was a subspectacular abscess. Follow-up revealed that the SIS graft provided excellent healing and cosmesis of the surgical site. CONCLUSIONS: While there are reports of lymphatic fluid dissection between skin layers during ecdysis, which can result in an opaque spectacle, the fluid opacity in this case was attributed to a subspectacular abscess secondary to an ascending oral infection. Addition of biological wound dressing may contribute to positive post-enucleation outcome in the snake.


Assuntos
Abscesso/veterinária , Infecções por Clostridium/veterinária , Clostridium perfringens/isolamento & purificação , Infecções Oculares Bacterianas/veterinária , Serpentes , Abscesso/diagnóstico , Abscesso/cirurgia , Animais , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/cirurgia , Diagnóstico Diferencial , Enucleação Ocular/veterinária , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/cirurgia
10.
JBJS Case Connect ; 10(1): e0266, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32224686

RESUMO

CASE: We describe the case of an 85-year-old woman who presented with worsening right hip pain after a conversion hip replacement. Subsequent imaging demonstrated a gas-containing collection in the lateral thigh. She was taken to the operating room for irrigation and debridement, where intraoperative cultures returned positive for Clostridium difficile. Surgical management was followed by a prolonged course of antibiotics. CONCLUSIONS: Clostridium difficile as the etiology of infection in a conversion arthroplasty is exceedingly rare. Orthopaedic surgeons and infectious disease specialists should consider C. diff as a potential cause of infection in conversion hip arthroplasty because management options will need to be tailored.


Assuntos
Artroplastia de Quadril/efeitos adversos , Clostridioides difficile/isolamento & purificação , Infecções por Clostridium/etiologia , Infecção da Ferida Cirúrgica/microbiologia , Idoso de 80 Anos ou mais , Infecções por Clostridium/diagnóstico por imagem , Infecções por Clostridium/cirurgia , Feminino , Fraturas do Quadril/cirurgia , Humanos , Infecção da Ferida Cirúrgica/diagnóstico por imagem , Infecção da Ferida Cirúrgica/cirurgia
11.
Int J Colorectal Dis ; 35(1): 1-8, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31748820

RESUMO

PURPOSE: Surgical consultation is recommended for all patients with fulminant Clostridioides difficile infection (CDI). If surgery is required, total abdominal colectomy (TAC) is most commonly performed. However, diverting loop ileostomy and colonic lavage have been recently developed as a potential colon-sparing approach to fulminant CDI. The aim of this review is to compare TAC and diverting loop ileostomy with colonic lavage for fulminant CDI. METHODS: Search of MEDLINE, EMBASE, CENTRAL, and PubMed was performed. Articles were eligible for inclusion if they compared TAC and diverting loop ileostomy with colonic lavage. The primary outcome was postoperative mortality, and the secondary outcome was postoperative complications. Quality of included studies was assessed using Newcastle-Ottawa Scale. RESULTS: From 64 relevant citations, 5 studies (4 retrospective cohorts, 1 case series) with 3683 patients were included. Compared to TAC, diverting loop ileostomy with colonic lavage did not significantly reduce overall mortality (RR 1.10, 95% CI 0.60 to 1.99, P = 0.77), rate of reoperation (RR 1.02, 95% CI, 0.63 to 1.63, P = 0.94), or overall postoperative complications (RR 0.51, 95% CI, 0.22 to 1.17, P = 0.11). Rates of colonic preservation with the use of diverting loop ileostomy with colonic lavage ranged from 76% to 100%. CONCLUSION: There does not appear to be a survival advantage with the use of diverting loop ileostomy with colonic lavage compared to TAC for fulminant CDI. However, diverting loop ileostomy with colonic lavage results in increased rates of colonic preservation, restoration of intestinal continuity, and laparoscopic surgery. This review is limited by the small number of included studies.


Assuntos
Clostridioides difficile/fisiologia , Infecções por Clostridium/microbiologia , Infecções por Clostridium/cirurgia , Colectomia , Ileostomia , Irrigação Terapêutica , Infecções por Clostridium/mortalidade , Colectomia/efeitos adversos , Humanos , Ileostomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Viés de Publicação , Reoperação , Irrigação Terapêutica/efeitos adversos , Resultado do Tratamento
12.
Surg Infect (Larchmt) ; 20(5): 411-415, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30900947

RESUMO

Background: Clostridioides difficile infection (CDI) accounts for as many as 25% of episodes of antibiotic-associated diarrhea and is the most common cause of healthcare-associated diarrhea. Rectal vancomycin irrigation is a therapy option; however, evidence is limited for its value post-colectomy. The objective of this study was to describe outcomes of patients who underwent total colectomy for fulminant C. difficile colitis and received rectal vancomycin post-operatively. Methods: This was a single-center retrospective chart review of adult patients who underwent total colectomy for fulminant CDI. Efficacy outcomes were all-cause in-hospital death, intensive care unit (ICU) and hospital length of stay, ventilator-free days at day 28 post-procedure, development of proctitis or pseudomembranes, need for re-initiation of CDI therapy, and normalization of infectious signs and symptoms at completion of CDI therapy. The primary safety outcome was the incidence of rectal stump blowout. Results: Of the 50 patients included, 38 (76%) received treatment with rectal vancomycin at the discretion of the surgeon. The Sequential Organ Failure Assessment score on the day of the procedure was higher in the rectal vancomycin group; however, this difference did not reach statistical significance. No difference was observed between the groups in the primary outcome of all-cause death. There was no significant difference between the groups for hospital length of stay, but there was a trend toward longer ICU length of stay for patients who received rectal vancomycin (9.5 days vs. 2.5 days; p = 0.05). No differences in the remaining secondary efficacy outcomes were observed. No episodes of rectal stump blowout were observed in either group. Conclusions: This study aimed to add to the limited data on the use of rectal vancomycin irrigation post-colectomy for toxic C. difficile colitis. Although our results do not support routine use of rectal vancomycin irrigation, they suggest that this therapy is not harmful if providers are considering its use for severe infections refractory to alternative treatment.


Assuntos
Antibacterianos/administração & dosagem , Infecções por Clostridium/tratamento farmacológico , Colite/tratamento farmacológico , Irrigação Terapêutica/métodos , Vancomicina/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Clostridium/cirurgia , Colectomia , Colite/cirurgia , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento
13.
J Am Coll Surg ; 228(6): 925-930, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30576799

RESUMO

BACKGROUND: Patients with severe, complicated Clostridium difficile infection (CDI) may ultimately require a colectomy. Although associated with high morbidity and mortality, a total colectomy has been the mainstay of surgical treatment. However, small studies have suggested partial colectomy may provide equivalent outcomes. We compared the outcomes of partial and total colectomy for CDI in a nationwide database. STUDY DESIGN: We performed a retrospective study using the American College of Surgeons National Surgical Quality Improvement Project (NSQIP). Patients with a primary diagnosis of Clostridium difficile colitis from 2007 to 2015, who underwent a total abdominal or partial colectomy, were analyzed. Postoperative mortality rate, complications, and length of stay were evaluated. Logistic regression controlling for patient and clinical factors evaluated the impact of type of operation performed. RESULTS: There were 733 colectomies for CDI, of which 151 (20.6%) were partial colectomies. Patients with a partial colectomy had a slightly higher 30-day mortality rate (37.1%) compared with total abdominal colectomy patients (34.7%, p = 0.58). However, logistic regression controlling for patient factors demonstrated no statistically significant difference for partial colectomy in 30-day mortality (odds ratio [OR] 1.21, 95% CI 0.76 to 1.96) or complication rate (OR 0.92, 95% CI 0.51 to 1.62) compared with total colectomy. There was no difference in days to surgery (4.6 partial vs 5.0 total, p = 0.70). Total abdominal colectomy trended toward a longer postoperative stay (18.0 vs 15.1 days for partial, p = 0.08). CONCLUSIONS: In a national database, a significant percentage of operations for CDI are partial colectomies. There were no significant differences found in mortality or complications between partial and total colectomy for severe complicated CDI.


Assuntos
Infecções por Clostridium/cirurgia , Colectomia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Clostridium/complicações , Infecções por Clostridium/mortalidade , Colectomia/mortalidade , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida
14.
Dig Dis Sci ; 64(6): 1632-1639, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30569334

RESUMO

BACKGROUND: Obesity and inflammatory bowel disease (IBD) are associated with increased risk of Clostridium difficile infection (CDI). The effect of obesity on IBD course and development of complications is poorly understood. We performed this study to examine the effect of obesity on CDI-related morbidity and mortality in hospitalized patients with IBD. METHODS: We used data from the National Inpatient Sample across five study years (2010-2014) to identify patients ≥ 18 years hospitalized with both CDI and IBD. We compared the outcomes of in-hospital mortality, partial or total colectomy, hospital length of stay, and hospital charges between obese and non-obese IBD-CDI patients. Analysis included univariate and multivariate linear and logistic regression analyses. RESULTS: Of 304,298 hospitalized patients with IBD, 13,517 (4.4%) patients had CDI. Of these, 996 (7.4%) patients were obese. Obese IBD-CDI patients had a higher risk of colectomy (adjusted odds ratio, AOR 1.60, 95% CI 1.30-1.96; p < 0.001), longer hospital length of stay (difference 0.8 days, 95% CI 0.02-1.58; p = 0.04), and higher hospital charges (difference $11,051, 95% CI 1939-20,163; p = 0.02) than non-obese IBD-CDI patients, but no significant difference in mortality was found between the two groups. CONCLUSIONS: Obesity is associated with a 60% increase in the risk of colectomy, longer hospital stay, and higher charges in IBD patients hospitalized with CDI. Further epidemiological and clinical studies are needed to confirm these findings.


Assuntos
Infecções por Clostridium/cirurgia , Colectomia , Hospitalização , Doenças Inflamatórias Intestinais/cirurgia , Obesidade/epidemiologia , Adulto , Idoso , Infecções por Clostridium/mortalidade , Colectomia/efeitos adversos , Colectomia/mortalidade , Bases de Dados Factuais , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Doenças Inflamatórias Intestinais/mortalidade , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Obesidade/mortalidade , Prevalência , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia
15.
Am J Surg ; 217(1): 34-39, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30266417

RESUMO

BACKGROUND: We aim to compare outcomes between loop ileostomy (LI) and total abdominal colectomy (TAC) for clostridium difficile infection (CDI) and hypothesize that LI is associated with fewer complications. METHODS: The 2011-2016 ACS-NSQIP database was queried for patients undergoing LI or TAC for CDI. Patients with high outlying age, LOS, and operative time were excluded. Statistics were performed using IBM-SPSS and NCSS PASS-11. RESULTS: Of 457 patients identified, 47 underwent LI. Predicted morbidity was higher in the TAC cohort (62% vs. 37%, p < 0.001). Patients in the LI cohort experienced fewer complications (72% vs. 87%, p = 0.021); however, mortality did not differ between LI (36%) and TAC (31%). Blood transfusions were more than twice as frequent in the TAC cohort (54% vs. 19%, p < 0.001). Four patients in the LI cohort required reoperation; however, none required colectomy. CONCLUSIONS: No mortality difference was observed between LI and TAC. Prospective studies are required to determine the utility of LI. SUMMARY: An analysis of the ACS-NSQIP database was performed and demonstrates that no survival benefit exists for patients who undergo loop ileostomy for C difficile infection compared to those who undergo total colectomy; however, patients who undergo loop ileostomy are likely to retain their colon with low risk of requiring subsequent colectomy.


Assuntos
Clostridioides difficile , Infecções por Clostridium/cirurgia , Colectomia/efeitos adversos , Colite/cirurgia , Ileostomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Idoso , Infecções por Clostridium/mortalidade , Colite/microbiologia , Colite/mortalidade , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Análise de Sobrevida
17.
Stat Methods Med Res ; 27(10): 2906-2917, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-28178876

RESUMO

Fecal microbiota transplantation is a highly effective intervention for patients suffering from recurrent Clostridium difficile, a common hospital-acquired infection. Fecal microbiota transplantation's success as a therapy for C. difficile has inspired interest in performing clinical trials that experiment with fecal microbiota transplantation as a therapy for other conditions like inflammatory bowel disease, obesity, diabetes, and Parkinson's disease. Results from clinical trials that use fecal microbiota transplantation to treat inflammatory bowel disease suggest that, for at least one condition beyond C. difficile, most fecal microbiota transplantation donors produce stool that is not efficacious. The optimal strategies for identifying and using efficacious donors have not been investigated. We therefore examined the optimal Bayesian response-adaptive strategy for allocating patients to donors and formulated a computationally tractable myopic heuristic. This heuristic computes the probability that a donor is efficacious by updating prior expectations about the efficacy of fecal microbiota transplantation, the placebo rate, and the fraction of donors that produce efficacious stool. In simulations designed to mimic a recent fecal microbiota transplantation clinical trial, for which traditional power calculations predict [Formula: see text] statistical power, we found that accounting for differences in donor stool efficacy reduced the predicted statistical power to [Formula: see text]. For these simulations, using the heuristic Bayesian allocation strategy more than quadrupled the statistical power to [Formula: see text]. We use the results of similar simulations to make recommendations about the number of patients, the number of donors, and the choice of clinical endpoint that clinical trials should use to optimize their ability to detect if fecal microbiota transplantation is effective for treating a condition.


Assuntos
Infecções por Clostridium/cirurgia , Transplante de Microbiota Fecal , Projetos de Pesquisa , Teorema de Bayes , Clostridioides difficile/isolamento & purificação , Humanos , Resultado do Tratamento
18.
Clin Infect Dis ; 66(2): 299-300, 2018 01 06.
Artigo em Inglês | MEDLINE | ID: mdl-29020255

RESUMO

Rarely, in fulminant Clostridium difficile infection (CDI), the rectal stump is persistently infected following total abdominal colectomy. We report cure of a septic patient with proctitis by fecal microbiota transplant via rectal swabs (mini-FMT). This novel procedure offers a management option for recurrent CDI following total abdominal colectomy.


Assuntos
Infecções por Clostridium/cirurgia , Infecções por Clostridium/terapia , Colectomia , Transplante de Microbiota Fecal/métodos , Complicações Pós-Operatórias/terapia , Proctite/terapia , Idoso , Humanos , Masculino , Resultado do Tratamento
19.
J Med Case Rep ; 11(1): 268, 2017 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-28931420

RESUMO

BACKGROUND: Clostridium septicum-infected aortic aneurysm is a fatal and rare disease. We present a fatal case of C. septicum-infected aortic aneurysm and a pertinent literature review with treatment suggestions for reducing mortality rates. CASE PRESENTATION: A 58-year-old Japanese man with an unremarkable medical history presented with a 3-day history of mild weakness in both legs, and experienced paraplegia and paresthesia a day before admission. Upon recognition of signs of an abdominal aortic aneurysm and paraplegia, we suspected an occluded Adamkiewicz artery and performed a contrast-enhanced computed tomography scan, which revealed an aortic aneurysm with periaortic gas extending from his chest to his abdomen and both kidneys. Antibiotics were initiated followed by emergency surgery for source control of the infection. However, owing to his poor condition and septic shock, aortic repair was not possible. We performed bilateral nephrectomy as a possible source control, after which we initiated mechanical ventilation, continuous hemodialysis, and hemoperfusion. A culture of the samples taken from the infected region and four consecutive blood cultures yielded C. septicum. His condition gradually improved postoperatively; however, on postoperative day 10, massive hemorrhage due to aortic rupture resulted in his death. CONCLUSIONS: In this patient, C. septicum was thought to have entered his blood through a gastrointestinal tumor, infected the aorta, and spread to his kidneys. However, we were uncertain whether there was an associated malignancy. A literature review of C. septicum-related aneurysms revealed the following: 6-month mortality, 79.5%; periaortic gas present in 92.6% of cases; no standard operative procedure and no guidelines for antimicrobial administration established; and C. septicum was associated with cancer in 82.5% of cases. Thus, we advocate for early diagnosis via the identification of periaortic gas, as an aortic aneurysm progresses rapidly. To reduce the risk of reinfection as well as infection of other sites, there is the need for concurrent surgical management of the aneurysm and any associated malignancy. We recommend debridement of the infectious focus and in situ vascular graft with omental coverage. Postoperatively, orally administered antibiotics must be continued indefinitely (chronic suppression therapy). We believe that these treatments will decrease mortality due to C. septicum-infected aortic aneurysms.


Assuntos
Aneurisma Infectado/diagnóstico por imagem , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Gangrena Gasosa/diagnóstico por imagem , Aneurisma Infectado/complicações , Aneurisma da Aorta Abdominal/complicações , Ruptura Aórtica , Infecções por Clostridium/complicações , Infecções por Clostridium/diagnóstico por imagem , Infecções por Clostridium/cirurgia , Clostridium septicum , Diagnóstico Precoce , Evolução Fatal , Gangrena Gasosa/complicações , Gangrena Gasosa/cirurgia , Humanos , Infarto/complicações , Infarto/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Nefrectomia , Isquemia do Cordão Espinal/complicações , Isquemia do Cordão Espinal/diagnóstico por imagem , Tomografia Computadorizada por Raios X
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