Introduction: Reports describe both an increased and a decreased incidence of Clostridium difficile (C.diff) infections associated within the context of antibiotic or antiseptic practice change. Due to increases in C. diff colitis refractory to medical management, we examined disease incidence in a 500 bed university teaching hospital.
Methods: Billing, hospital, and infection control databases (1/1/90-9/30/06) were used to identify individual patients positive for C. diff toxin assay. We examined the records of patients with fulminate C. diff colitis requiring colectomy.
Results: A near linear (figure 1, r2= 0.90) increase in C. diff incidence unrelated to hospital admissions occurred over the 16 years (1990- 14 cases to 2006- 927 cases over the 1st 9 months). Tabulated in 5 year increments, a simultaneous linear increase in colectomies (n=14) were performed for uncontrolled C. diff colitis (figure 2). The ratio of colectomy / C. diff cases however did not change:’90-’95—1/598(0.17%); ’96-’00—5/2486(0.2%);’01-05—9/4504(0.20%) with overall average ratio of 1:505(0.19%). 83% of patients with refractory colitis were immunosuppressed. Operative mortality was 67% despite successful total abdominal colectomy.
Conclusion: Incidence of C. diff infection has increased dramatically over the past 16 years resulting in proportionately more medical failures and the need for surgical control of the disease. The colectomy rate per case of C. diff colitis has remained steady suggesting this pathogen is not increasing in virulence. This is a highly lethal complication of a disease process which is increasing in incidence very rapidly.