Background: The clinical spectrum of Clostridium difficile (CD) infection ranges from mild diarrhea to fulminant colitis with multi-organ failure and death. Emerging data show that both the incidence and the virulence of CD infection are increasing. Risk factors for developing CD infection include prolonged hospital stay and prior antibiotic use. Patients with necrotizing pancreatitis (NP) uniformly require prolonged hospitalization and commonly receive broad spectrum antibiotic treatment. We therefore hypothesized that patients with NP would be at increased risk for developing CD, and that NP patients with CD infection would have a more severe clinical course than those without CD infection. Methods: Administrative data from all patients hospitalized at our institution between January 2003 and December 2007 were reviewed. Of 255 patients with NP, 24 (9%) had a CD toxin confirmed assay (CD positive). These patients were matched by age, gender, body mass index (BMI), medical co-morbidities (diabetes, hypertension, coronary artery disease, pulmonary disease), and severity of pancreatitis with 24 patients without CD infection (CD negative). Clinical outcomes were compared. Data were analyzed with Student t-test, Chi square and Fisher exact test. P value of less than 0.05 was considered statistically significant.Results: The incidence of CD infection in all patients hospitalized during this time period (n= 56,668) was 2%. The incidence of CD infection was significantly higher (24/255, 9%) in patients with NP during this time period (p<0.001). Length of stay, number of readmissions, hospital mortality, and need for colectomy were similar in NP patients with and without CD infection (Table). Five patients in the CD positive group underwent colectomy; however, only one colectomy was required for CD toxic megacolon. Conclusions: These data show that patients with necrotizing pancreatitis have a significantly increased incidence of Clostridium difficile infection compared to the general hospital population. Surprisingly, patients with necrotizing pancreatitis and Clostridium difficile infection had similar outcomes to those without Clostridium difficile infection. Judicious antibiotic use may decrease Clostridium difficile infection in patients with necrotizing pancreatitis.

Group	Length of stay (d)	Re admission (#)	Mortality (%)	Colectomy (#)
CD Positive	46.7±4	1.8±0.3	0%	5
CD Negative	40.1±4	1.8±0.4	12%	3