R. B. Interiano1,2, J. Wolf4,5, S. Arnold4, R. F. Williams1,2 1University Of Tennessee Health Science Center,Surgery,Memphis, TN, USA 2St. Jude Children’s Research Hospital,Surgery,Memphis, TN, USA 4University Of Tennessee Health Science Center,Infectious Diseases,Memphis, TN, USA 5St. Jude Children’s Research Hospital,Infectious Diseases,Memphis, TN, USA
Introduction: Clostridium difficile colitis is a common cause of antibiotic-associated diarrhea, with an increased incidence in adults and children over the past two decades. While colectomy is associated with an increase in mortality in adults, little data exists as to the age-related outcomes for surgery in children with severe C. difficile infections (CDI).
Methods: Laboratory results, surgical interventions, and pathology reports were reviewed for all patients with a positive laboratory result for C. difficile at our two institutions from January 2003 to December 2012. Thirty-day mortality was evaluated to assess whether the CDI had contributed to the demise of those patients.
Results: Six-hundred fourteen patients with positive laboratory results were identified at a primarily pediatric oncologic research hospital, while 448 patients were identified at an urban level 1 pediatric hospital. Of these patients, no patients were found to have died within 30 days from the positive test as a result of the infection as assessed by clinical notes and autopsy results when available. No patients in this study cohort required bowel resection or colectomy as a result of CDI. Two patients were identified who required exploration – both for ascites causing respiratory insufficiency. While the colon was noted to be either dilated or inflamed, neither patient required a bowel resection.
Conclusion: Fulminant CDI is a disease associated with a high mortality in the adult population, while the rate of fulminant disease requiring resection appears to be much lower in children. Efforts to predict which pediatric patients may benefit from any surgical intervention may be hindered by the paucity in cases identified.
