What Goes Wrong In Surgical Patients With Concomitant Clostridium Difficile Infection Disease? Risk Factors For In-Hospital Mortality

Aim: to evaluate the possible anthropometric, clinical, biological, and pathological factors that could be associated with an increased mortality of the surgical patients with concomitant CD infection. Material and methods: The study was carried out on a group of 123 surgical patients who were operated in the IIIrd Surgical Unit of the "Sf. Spiridon" University Hospital Romania and were diagnosed with CDI during hospitalization. Results: We noted 20 deaths among the patients from our study group. Characteristic for the deceased patient's group was the presence of sepsis before or after CDI diagnosis (p = 0.001). The involving of a parenchymal organ (p = 0.001) and the presence of metastases (p = 0.025) were significantly higher in the deceased patient's group. Reintervention induced an estimated risk of death approximately 2-fold higher (p = 0.002). The estimated risk of death was slightly higher in patients with renal chronic disease (p = 0.001), obesity (p = 0.009), Diabetes Mellitus (p = 0.005) and chronic cardiac insufficiency (p = 0.05). All patients who died had surgical diseases requiring postoperative antibiotic treatment (p = 0.001) especially with Cephalosporin (p = 0.003) and Clindamycin (p = 0.047). The use of proton pump inhibitor and anticoagulant medication was statistically higher in patients who died. Conclusions: Unfavorable evolution of surgical patients with CDI is highly associated with obesity, renal chronic disease, chronic cardiac insufficiency, diabetes, chronic oral anticoagulants prior to CDI, treatment with third generation cephalosporin, clindamycin, and PPI after surgery.