Original Research Article| Volume 225, ISSUE 1, P118-121, January 2023

Risk factors for clostridium difficile infection in general surgery patients

Published:September 21, 2022DOI:


      • General surgery patients are at increased risk for clostridium difficile infection.
      • Emergent surgery and infection are risk factors for clostridium difficile.
      • Longer time prior to surgery is a risk factor for clostridium difficile.
      • Laparoscopic surgery may be a protective factor for clostridium difficile.



      Clostridium Difficile Infection (CDI) is a significant cause of mortality. This study aims to identify predictors of CDI in general surgery patients.


      Patients who underwent general surgery operations in the 2019 National Surgical Quality Improvement Program database were identified with demographic, intervention, and outcome data abstracted. Patients with CDI and no CDI were compared by univariate analysis. Multivariable logistic regression (MLR) was performed to determine independent predictors of CDI.


      Of 436,831 surgical patients, 1,840 patients were diagnosed with CDI (0.4%). Patients with CDI have a higher mortality (2.1% vs 0.76%,p < 0.0001), longer length of stay (7 days vs 1 day, p < 0.0001), and are less likely to undergo a laparoscopic procedure (29.9% vs 37.5%, p < 0.0001). MLR identified older age, emergent operation, increased time to operation, surgical site infection, deep organ space infection, steroid use, metastatic cancer, smoking, and decreased body mass index (BMI) as independent predictors of CDI.


      CDI is rare following general surgery. Infections, delay to operation, and emergency operations are associated with CDI.


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        • Magill S.S.
        • et al.
        Multistate point-prevalence survey of health care-associated infections.
        N Engl J Med. 2014; 370: 1198-1208
        • Centers for Disease Control and Prevention
        November 23). 2019 Antibiotic Resistance Threats Report.
        Centers for Disease Control and Prevention, 2021 (Retrieved January 26, 2022, from)
        • Dubberke E.R.
        • et al.
        Identification of medicare recipients at highest risk for Clostridium difficile infection in the US by population attributable risk analysis.
        PLoS One. 2016; 11e0146822
        • Li X.
        • et al.
        Analysis of morbidity and mortality outcomes in postoperative Clostridium difficile infection in the Veterans health administration.
        JAMA Surg. 2016; 151: 314-322
        • Bovonratwet P.
        • et al.
        How common-and how serious- is Clostridium difficile colitis after geriatric hip fracture? Findings from the NSQIP dataset.
        Clin Orthop Relat Res. 2018; 476: 453-462
        • Bovonratwet P.
        • et al.
        Incidence, risk factors, and impact of Clostridium difficile colitis following primary total hip and knee arthroplasty.
        J Arthroplasty. 2018; 33 (e201): 205-210
        • Bovonratwet P.
        • et al.
        Incidence, risk factors, and impact of Clostridium difficile colitis after spine surgery: an analysis of a national database.
        Spine. 2018; 43: 861-868
        • Karamanos E.
        • Wang H.
        • Shah A.R.
        Infection in the plastic surgery population: lessons from the ACS NSQIP database.
        Plast Reconstr Surg Glob Open. 2020; 8e3281
        • Kong K.
        • et al.
        Analysis of perioperative risk factors for Clostridium difficile infection after a colectomy.
        Cureus. 2021; 13e20142
        • Coleoglou Centeno A.A.
        • et al.
        Early emergency general surgery is associated with a higher incidence of Clostridium difficile infection.
        Surg Infect. 2019; 20: 10-15
        • Dang T.T.
        • et al.
        Clostridium difficile and laparoscopic bariatric surgery: an analysis of the metabolic and bariatric surgery accreditation and quality improvement Program database.
        Obes Surg. 2019; 29: 1881-1888
        • Damle R.N.
        • et al.
        Clostridium difficile infection after colorectal surgery: a rare but costly complication.
        J Gastrointest Surg. 2014; 18: 1804-1811
        • Gabriel V.
        • et al.
        A propensity score analysis of Clostridium difficile infection among adult trauma patients.
        Surg Infect. 2018; 19: 661-666
        • Abdelsattar Z.M.
        • et al.
        Postoperative burden of hospital-acquired Clostridium difficile infection.
        Infect Control Hosp Epidemiol. 2015; 36: 40-46
        • Bloomfield M.G.
        • Sherwin J.C.
        • Gkrania-Klotsas E.
        Risk factors for mortality in Clostridium difficile infection in the general hospital population: a systematic review.
        J Hosp Infect. 2012; 82: 1-12
        • Rogers M.A.
        • et al.
        Higher rates of Clostridium difficile infection among smokers.
        PLoS One. 2012; 7e42091
        • Bishara J.
        • et al.
        Obesity as a risk factor for Clostridium difficile infection.
        Clin Infect Dis. 2013; 57: 489-493
        • Chandradas S.
        • et al.
        Does obesity influence the risk of Clostridium difficile infection among patients with ulcerative colitis?.
        Dig Dis Sci. 2018; 63: 2445-2450
        • Meier K.
        • et al.
        Obesity as protective against, rather than a risk factor for, postoperative Clostridium difficile infection: a nationwide retrospective analysis of 1,426,807 surgical patients.
        J Trauma Acute Care Surg. 2019; 86: 1001-1009
        • Bhangu A.
        • et al.
        Systematic review and meta-analysis of outcomes following emergency surgery for Clostridium difficile colitis.
        Br J Surg. 2012; 99: 1501-1513