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Diverticular Disease of the Colon Does Not Increase Risk of Repeat C. difficile Infection

Feuerstadt, Paul MD*; Das, Rohit MD; Brandt, Lawrence J. MD, MACG, AGAF

Journal of Clinical Gastroenterology: May/June 2013 - Volume 47 - Issue 5 - p 426–431
doi: 10.1097/MCG.0b013e318276beea
ALIMENTARY TRACT: Original Articles
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Background: Studies have suggested that colonic diverticulosis might increase the likelihood of repeat Clostridium difficile infection (CDI). Our study was designed to compare rates of repeat infection in patients with and without colon diverticula.

Methods: Patients who had a positive C. difficile toxin assay and colonoscopic evidence of diverticulosis were classified as CDI and diverticulosis (CDI-D), whereas those with a positive toxin assay but no such colonoscopic evidence were classified as CDI and no diverticulosis (CDI-ND). Various clinical and epidemiologic factors were recorded for each patient. Primary outcomes were “relapse” (repeat CDI within 3 mo of initial infection) and “recurrent” infection (repeat CDI≥3 mo after initial infection). Secondary outcomes 30 days after diagnosis were mortality, intensive care unit transfer, and continuous hospitalization.

Results: A total of 128 patients were classified as CDI-D, whereas 137 had CDI-ND. There were no significant differences between CDI-D and CDI-ND when comparing frequencies of repeat infection and its subclassifications, relapse or recurrence. There were, however, statistical associations seen between diverticulosis of the ascending colon and increased recurrence rates [hazard ratio (HR): 1.4±0.38, P<0.05] and decreased rates of relapse in diverticular disease of the descending (HR: 0.40±0.46, P<0.05), and sigmoid colon (HR: 0.39±0.49, P<0.05). The ascending colon association is limited by a small patient population. There were no significant differences in any of the 30-day outcomes including intensive care unit requirement, hospitalization stay, or mortality.

Conclusions: Patients with diverticular disease of the colon are not at increased risk of repeat CDI.

*Gastroenterology Center of Connecticut, Hamden, CT

Division of Gastroenterology

Montefiore Medical Center, Bronx, NY

Author Contributions: P.F.: Assisted in study concept and design, data collection, statistical analysis along with drafting and critical revision of the manuscript for intellectual content. R.D.: Assisted in data collection and manuscript writing. L.J.B.: Assisted in study concept and design, data analysis, along with drafting and critical revision of the manuscript for intellectual content.

The authors declare that they have nothing to disclose.

Reprints: Paul Feuerstadt, MD, Gastroenterology Center of Connecticut, Hamden, CT 06518 (e-mail: pfeuerstadt@gastrocenter.org).

Received March 29, 2012

Accepted September 28, 2012

© 2013 by Lippincott Williams & Wilkins