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Invited Critique
May 18, 2009

Fulminant Clostridium difficile Colitis—Invited Critique

Arch Surg. 2009;144(5):439-440. doi:10.1001/archsurg.2009.53

This review confirms the substantial mortality associated with fulminant C difficile colitis (FCDC). Independent predictors of mortality are similar to results from other reviews: advanced patient age (≥70 years), profound leukocytosis (≥35 000/μL), and the need for cardiopulmonary support. Nearly half of those who required colectomy were experiencing multisystem organ failure prior to surgery.

The fact that patients admitted to the surgical department experienced a better outcome is noteworthy. The authors speculate that improved survival in this cohort may reflect both the increased rate of urgent colectomy and the shorter interval between admission and operation for patients in the surgical department, a factor that has been associated with improved survival in other series. This subset analysis excludes 63 patients who developed FCDC while hospitalized for other medical problems. According to the report, 29 of these 63 patients were treated in the surgery department. Treatment outcome in these 29 patients could be germane to any comparison of differences in treatment strategy and patient outcome.