Pseudomembranous Colitis after Gastrointestinal Operation

ABSTRACT

PURPOSE: The risk factors of pseudomembranous colitis (PMC) are well known. However, there have been no studies of PMC after gastrointestinal operation. The aim of this study was to evaluate the risk factors and to establish the guiding principles for PMC after gastrointestinal operation. METHODS: We performed a retrospective study of 39 PMC patients after gastrointestinal operation from January 2004 to December 2008. A control group of one hundred and seventeen matched to a PMC group by date of operation was chosen in a random fashion. Preoperative, operative, and postoperative factors of PMC were evaluated. RESULTS: The incidence of PMC after gastrointestinal operation was 0.63%. On univariate analysis, among preoperative factors, albumin, PT-INR and neutropenia were significant risk factors for PMC. There was no difference in the operative factors. Among postoperative factors, duration of cephalosporin, aminoglycoside, H2 blocker administration were significant risk factors for PMC after gastrointestinal operation. And transfusion, duration of NPO, length of stay in intensive care unit (ICU) and postoperative intraabddominal abscess, pneumonia were also significant risk factors. On multivariate analysis, the independent risk factors for PMC after gastrointestinal operation were duration of aminoglycoside administration, transfusion volume and length of stay in ICU. When period of study was divided by three months, incidence of PMC at a specific period was high. After limiting of prophylactic antibiotics, incidence of PMC fell to 0.36%. CONCLUSION: To prevent PMC after gastrointestinal operation, we need sustained efforts to establish stricter guidelines about prophylactic antibiotics and transfusion, and to minimize length of stay in ICU.