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Fulminant Clostridium difficile Colitis: What can be done to control the Epidemics?
Yee Lee Cheah1, Sanda Tan2, Staci Fischer3, Victor E Pricolo4
1Department of Surgery, Rhode Island Hospital, Providence, RI;2Division of Colon & Rectal Surgery, Department of Surgery, Rhode Island Hospital, Providence, RI;3Division of Infectious Control, Department of Medicine, Rhode Island Hospital, Providence, RI;4Rhode Island Hospital, Providence, RI

Objective: To investigate the number of colectomies for fulminant C. difficile colitis performed at a single large academic hospital to determine a trend in occurrence.
Design: Retrospective chart review.
Setting: Tertiary care academic medical center.
Patients: All patients with fulminant colitis who required total abdominal colectomy from 2000 to April 2007. We reviewed data of individual patient’s medical records and defined cases of C. difficile colitis as having a positive toxin assay, endoscopic or histopathological evidence of pseudomembranous colitis.
Main Outcome Measures: Rate of colectomy for C. difficile colitis over an eight year period.
Results: There has been an eight-fold increase in the number of colectomies for C. difficile from 2000 to 2007. The postoperative mortality rate was 41%.

Conclusion: Since 2005, we observed a significant increase in the number of fulminant colitis requiring colectomy. The CDC has confirmed the presence of virulent strain NAP1/027 in New England. C. difficile is not a reportable disease in the US, true prevalence of infection and the morbidity and mortality associated with infection are difficult to ascertain. In order to better define the epidemiology, stool cultures and isolates should be referred to state health departments and the CDC for typing. Strict isolation procedures may play a limited role to control outbreaks, while antibiotic stewardship may have a greater impact.

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