Early colectomy may be associated with improved survival in fulminant Clostridium difficile colitis: an 8-year experience

BACKGROUND: We hypothesized that colectomy for fulminant Clostridium difficile colitis (CDC) before organ failure would be associated with decreased mortality. METHODS: Data were retrospectively collected on patients operated on for CDC between 2000 and 2007. Variables examined included age, sex, immunodeficiency, recurrent CDC, vasopressor requirement, acute respiratory failure, acute renal failure, white blood cell count, and stress ulcer prophylaxis. Univariate and multivariate analyses were performed to identify predictors of mortality. RESULTS: During this period, 6,841 patients were diagnosed with CDC and 69 patients underwent surgery. Independent predictors of mortality were age >65 years (odds ratio [OR] 6.8, confidence interval [CI] 1.4-32.3, P =.0 16), acute respiratory failure (OR 5.4, Cl 1.6-18.1, P=.007), and acute renal failure (OR 3.8, CI 1.1-13.1, P=.035). CONCLUSIONS: Colectomy before the development of organ failure is associated with decreased mortality in patients with fulminant CDC, especially in those >65 years old. (C) 2009 Published by Elsevier Inc.