A Prospective Program to Reduce the Clinical Incidence of Clostridium difficile Colitis Infection after Cystectomy

Adam C. Calaway, Joseph M. Jacob, Yan Tong, Luke Shumaker, Weston Kitley, Ronald S. Boris, K. Clinton Cary, Hristos Kaimakliotis, Timothy Masterson, Richard Bihrle, Michael Koch

Research output: Contribution to journalArticle

Abstract

PURPOSE: The development of Clostridium difficile infection after cystectomy is associated with significant morbidity and mortality. We implemented a prospective screening program to identify asymptomatic carriers of C. difficile and assessed its impact on clinical C. difficile infection rates compared to historical matched controls. MATERIALS AND METHODS: Prospective C. difficile screening prior to cystectomy began in March 2015. The 380 consecutive patients who underwent cystectomy before the initiation of screening (control cohort) were matched based on 5 clinical factors with the 386 patients who underwent cystectomy from March 2015 to December 2017 (trial cohort). Patients who screened positive were placed in contact isolation and treated prophylactically with metronidazole. Multivariable models were built on an intent to screen basis and an effectiveness of screening basis to determine whether screening reduced the rate of symptomatic C. difficile infection postoperatively. RESULTS: With the implementation of the screening protocol the C. difficile infection rate declined from 9.4% to 5.5% (OR 0.52, p = 0.0268) in patients on the intent to screen protocol and from 9.2% to 4.9% in those on the effectiveness of screening protocol (OR 0.46, p = 0.0174). CONCLUSIONS: C. difficile screening prior to cystectomy is associated with a significant decrease in the rate of clinically symptomatic infection postoperatively. These results should be confirmed in a randomized controlled trial.

Original languageEnglish (US)
Pages (from-to)342-349
Number of pages8
JournalThe Journal of Urology
Volume201
Issue number2
DOIs
StatePublished - Feb 1 2019

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Clostridium difficile
Cystectomy
Colitis
Clostridium Infections
Incidence
Infection
Metronidazole
Randomized Controlled Trials
Morbidity
Mortality

ASJC Scopus subject areas

  • Urology

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A Prospective Program to Reduce the Clinical Incidence of Clostridium difficile Colitis Infection after Cystectomy. / Calaway, Adam C.; Jacob, Joseph M.; Tong, Yan; Shumaker, Luke; Kitley, Weston; Boris, Ronald S.; Cary, K. Clinton; Kaimakliotis, Hristos; Masterson, Timothy; Bihrle, Richard; Koch, Michael.

In: The Journal of Urology, Vol. 201, No. 2, 01.02.2019, p. 342-349.

Research output: Contribution to journalArticle

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AU - Tong, Yan

AU - Shumaker, Luke

AU - Kitley, Weston

AU - Boris, Ronald S.

AU - Cary, K. Clinton

AU - Kaimakliotis, Hristos

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AU - Bihrle, Richard

AU - Koch, Michael

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AB - PURPOSE: The development of Clostridium difficile infection after cystectomy is associated with significant morbidity and mortality. We implemented a prospective screening program to identify asymptomatic carriers of C. difficile and assessed its impact on clinical C. difficile infection rates compared to historical matched controls. MATERIALS AND METHODS: Prospective C. difficile screening prior to cystectomy began in March 2015. The 380 consecutive patients who underwent cystectomy before the initiation of screening (control cohort) were matched based on 5 clinical factors with the 386 patients who underwent cystectomy from March 2015 to December 2017 (trial cohort). Patients who screened positive were placed in contact isolation and treated prophylactically with metronidazole. Multivariable models were built on an intent to screen basis and an effectiveness of screening basis to determine whether screening reduced the rate of symptomatic C. difficile infection postoperatively. RESULTS: With the implementation of the screening protocol the C. difficile infection rate declined from 9.4% to 5.5% (OR 0.52, p = 0.0268) in patients on the intent to screen protocol and from 9.2% to 4.9% in those on the effectiveness of screening protocol (OR 0.46, p = 0.0174). CONCLUSIONS: C. difficile screening prior to cystectomy is associated with a significant decrease in the rate of clinically symptomatic infection postoperatively. These results should be confirmed in a randomized controlled trial.

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