The incidence of Clostridium difficile infection (CDI) has been reported to be as high as 4% following ileostomy reversal.
CDI can be associated with significant morbidity.
Dr Harries and colleagues from the United Kingdom performed a systematic review to establish incidence, and to evaluate the factors that may contribute to an increased risk of CDI following ileostomy reversal.
The team searched Ovid, Embase and Medline.
Search terms included Clostridium difficile, reversal of ileostomy and ileostomy closure.
The team included articles where at least one case of Clostridium difficile-associated diarrhea following reversal of defunctioning ileostomy was reported.
|The overall incidence of CDI was 2%|
|Digestive Diseases & Sciences|
Data extraction for articles was performed by 2 authors, using predefined data fields.
The researchers' primary outcome measure was incidence of CDI amongst patients undergoing ileostomy reversal.
Secondary outcomes were defunctioning time, antibiotic regime, acid suppression, time to onset of symptoms and study conclusions including colectomy and mortality rate.
The team included 11 articles.
The researchers found that the overall incidence of CDI was 2%.
The mean defunctioning time was 9 months.
The research described a variety of antibiotic regimes.
Mean time to onset of symptoms was 6 days.
Use of acid suppression, colectomy or mortality rate were frequently not reported.
Dr Harries' team concludes, "CDI should be recognized as a potentially life-threatening complication of ileostomy closure."
"Careful consideration should be given to peri-operative antibiotic regime, acid suppression, timing of reversal and appropriate preoperative counselling of patients."