Clostridium difficile: What Is the Risk?
Esther K. Liu, DO1, Janae Preece, MD2, Kristina D. Suson, MD2.
1Detroit Medical Center, Detroit, MI, USA, 2Children's Hospital of Michigan, Detroit, MI, USA.
BACKGROUND: One rationale for improving antibiotic stewardship is decreasing the risk of Clostridium difficile infections (CDI). We studied CDI following urologic procedures in pediatric patients.
METHODS:The American College of Surgeons National Surgical Quality Improvement Program pediatric data file was queried for children undergoing surgery with pediatric urology or urology between 2015 and 2017. Data points included patient demographics (age, gender, race, ASA classification), surgery performed, and perioperative outcomes (operative time, admission status, length of stay, complications, readmission, and reoperation). Students T-test and Chi-square analyses were applied to detect differences between those with CDI and those without CDI.
RESULTS: Of the 27,193 patients undergoing urologic surgery, 36 (0.13%) were diagnosed with CDI. A complete list of surgeries after which patients developed CDI is presented in Table 1. Patients with CDI were more likely to be female (50% vs 28%, p=0.003) and inpatient (78% vs 34%, p=0.001) than those without. There was no difference in mean age (2026±295 CDI vs 1886±11 no CDI days) or race (p=0.426). Children with CDI had higher ASA classifications (p<0.001). Their mean operative times were longer (156.1±19.6 vs 105.2±0.6 min, p<0.001), as were their mean lengths of stay (4.6±0.8 vs 1.3±0.0 days, p<0.001). CDI patients were more likely to have other complications (44% vs 8%, p<0.001), Table 2. Among patients with CDI, 38.89% experienced concomitant infectious complications. There was no difference in reoperation rate (p=0.614), but more patients with CDI required readmission (56% vs 4%, p<0.001). A third of children with CDI had undergone vesicoureteral reflux correction, comprising 0.3% of the same CPT codes. Over 11% of children with CDI had undergone nephrectomy, comprising 1.1% of the same CPT codes for the highest rate. No CDI patients underwent surgical correction of hypospadias.
CONCLUSIONS: Occurring rarely, CDI is associated with significant morbidity, including longer hospitalization and increased rate of readmission. Although most children with CDI had undergone anti-reflux surgery, the rate following this surgery is low, occurring most commonly after nephrectomy. 
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