Post-Op Bacterial Infection Raises Odds for Complications, Death

Clostridium difficile can be devastating to patients recovering from surgery, experts say

Wednesday, November 25, 2015

WEDNESDAY, Nov. 25, 2015 (HealthDay News) -- People recuperating from surgery are much more likely to die or develop complications if they become infected with a dangerous diarrhea-causing bacteria, a new study suggests.

Patients at VA hospitals who contracted Clostridium difficile following surgery were five times more likely to die and 12 times more likely to suffer a complication of the heart, lung, kidneys or nervous system, according to findings published online Nov. 25 in the journal JAMA Surgery.

"C. difficile infection is a big hit to take for people who are already behind the eight-ball," said Dr. Brian Zuckerbraun, a surgeon at the VA Pittsburgh Healthcare System who co-wrote an accompanying editorial. "It's just a big insult to their system, when they are vulnerable."

C. difficile is a tough and opportunistic bacteria that can invade the intestines of people whose gut bacteria have been wiped out by heavy doses of antibiotics, according to the U.S. National Institutes of Health (NIH).

Patients with C. difficile suffer from severe diarrhea, fever, nausea and abdominal pain, the NIH says.

To see how C. difficile might affect people recovering from surgery, researchers led by Xinli Li, of the National Surgery Office of the Veterans Health Administration (VHA), reviewed data from more than 468,000 surgical procedures performed over four years through the VHA.

Slightly more than 1,800 of those patients developed a C. difficile infection within 30 days of surgery, amounting to a rate of 0.4 percent per year, the authors said.

The data also showed that 86 percent of surgical patients with a C. difficile infection wound up suffering from one or more complications, compared with just over 7 percent of people who had a healthy recovery from surgery.

In addition, about 5 percent of surgical patients with C. difficile died within 30 days of their operation, compared with 1 percent of those not infected by the bacteria.

Patients with C. difficile infection also remain in the hospital much longer, about 18 days compared to four days for those without the infection, the investigators found.

People recovering from transplant surgery were at greatest risk of a C. difficile infection, the findings showed.

The bacteria appears to be devastating for surgical patients because they are already recuperating from the trauma of surgery, said Dr. Amesh Adalja, a senior associate at the UPMC Center for Health Security in Baltimore.

"It can be the straw that breaks the camel's back," Adalja said. "It pushes them over the edge and they get all of these other complications. There is a whole cascade of effects that can occur becauseC. diff has overwhelmed the health of a person who was on the precipice to begin with."

Hospitals can combat C. difficile infection through strict and judicious use of antibiotics, Adalja and Zuckerbraun said. That way, patients are less likely to have their gut bacteria stripped away, leaving them open to infection.

Infection control also is important, but difficult. C. difficile is a spore that cannot be killed by the alcohol used in most antiseptics and hand sanitizers, Adalja said.

Because of this, hospitals have started adopting bleach-based solutions and other harsh disinfectants that have been proven to kill C. difficile, Zuckerbraun said. Adalja added that some facilities are using UV devices to kill off the bacteria.

Health care workers and caregivers at home can prevent C. difficile infection by washing their hands frequently with soap and water, and wearing gowns and gloves while caring for people, Adalja said.

"I think you're going to see a lot of attention placed on C. diff in the coming years," Adalja said.

SOURCES: Brian Zuckerbraun, M.D., surgeon, VA Pittsburgh Healthcare System; Amesh Adalja, M.D., senior associate, UPMC Center for Health Security, Baltimore; Nov. 25, 2015, JAMA Surgery, online

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