Tratamiento quirúrgico de la colitis grave por Clostridium difficile

Abstract

Introduction: Clostridium difficile infection is the most common healthcare associated infection (HCAI). In few severe cases it may need surgical treatment. Objectives: To show the results of a series treated by us. Material and Methods: Retrospective descriptive series of patients treated for severe C. difficile colitis from 2010 to 2013. Results: The series corresponds to 6 patients in whom severe C. difficile colitis was demonstrated. All had significant co-morbidities or had undergone major surgical procedures prior to infection. All showed a leukocyte count of 15,000 and had clinical or radiological evidence of colitis. Five patients were receiving specific treatment without success. The surgery performed was a total colectomy with ileostomy and closure of the rectal stump. The major morbidity was found in 4 patients with extended hospital stay for more than 15 days. Surgical mortality was two cases. Two patients were reconstituted and one of them had a second C. difficile infection in post operative with successful treatment. Conclusion: Colitis is a severe complication of C. difficile infection. The most recommended surgery is still total colectomy without anastomoses. Surgical mortality remains high despite advances in intensive care so HCAI control is essential in preventing it.