Severe Complicated Clostridium Difficile Infection: Can the UPMC Proposed Scoring System Predict the Need for Surgery?.

Introduction: Clostridium difficile infection (CDI) is one of the most common health care associated infections and it continues to have significant morbidity and mortality. The onset of fulminant colitis often requires total abdominal colectomy (TAC) with ileostomy, which has a mortality rate of 35% to 57%. University of Pittsburgh Medical Center (UPMC) developed a scoring system for severity and recommended surgical consultation for severe complicated disease. The aim of this study is to evaluate if the UPMC proposed scoring system for severe complicated CDI can predict the need for surgical intervention. Methods: This is a retrospective review of all patients who developed severe complicated CDI at Geisinger Medical Center between January 2007 and December 2012 as defined by the UPMC scoring system. Main outcomes were the need for surgical intervention and 30-day mortality. Results: Eighty-eight patients had severe complicated CDI based on the UPMC scoring system. Fifty-nine patients (67%) required surgery and twenty-nine did not. All patients were diagnosed with CDI by positive toxin assays. There was no difference between the groups with respect to age, gender, BMI, or co-morbidities. When comparing the surgical group to the non-surgical cohort, the surgical cohort averaged 20 points on the scoring system compared to 9 in the non-operative cohort. In patients with severe complicated CDI, 15 or more points predicted the need for surgery 75% of the time. Forty-two percent of the surgical cohort had respiratory failure requiring mechanical ventilation compared to 0% in the non-surgical cohort (p

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