Clostridium difficile infection:: A surgical disease in evolution

Introduction Several recent publications suggest an increase in the incidence of Clostridium difficile colitis. However, such studies commonly lack denominators over which to index this rise. There is also concern in the literature that disease virulence is increasing. Methods Billing, admission, operative, and infection databases at a single tertiary care center identified patients admitted from 1990 to 2006 with a diagnosis of C. difficile infection. Grouped by era, case numbers were indexed against overall hospital, operative, and laboratory volumes. C. difficile colectomy cases were individually examined and analyzed. Results The number of hospitalized patients diagnosed with C. difficile colitis increased in a linear fashion during the study period (1990, 14 cases; 2006, 927 cases). The colectomy per C. difficile case ratio did not change over the study period (era 1, 0.17%; era 2, 0.20%; era 3, 0.16%). Thirteen patients underwent colectomy with 54% surviving. The increase in patients admitted with a diagnosis of C. difficile was significantly associated with hospital volume (p=0.04), operative volume (p<0.001), and lab testing volume (p=0.008). Conclusion The number of C. difficile patients admitted to our hospital is rising at an alarming rate. This reflects national trends and urgent action seems warranted to prevent a C. difficile epidemic.