Selenne A. Arzola-Clemente, Unidad Médica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
Moisés F. Rojas-Illañes, Unidad Médica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
Briseida Rubio-Martínez, Unidad Médica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
Jorge Garza-Sánchez, Departamento de Coloproctología, Hospital Ángeles Puebla, Puebla, México
Jaime A. Hernández-Ruiz, Departamento de Coloproctología, Hospital Ángeles Puebla, Puebla, México
Juan A. Villanueva-Herrero, Anorectal Physiology Unit, Coloproctology Service, Hospital General de México “Dr. Eduardo Liceaga”, Mexico City, Mexico
Jorge L. De León-Rendón, Departamento de Coloproctología, Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México
Billy Jiménez-Bobadilla, Servicio de Coloproctología, Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México
Carlos A. López-Bernal, Anorectal Physiology Unit, Coloproctology Service, Hospital General de México “Dr. Eduardo Liceaga”, Mexico City, Mexico
Objective: To identify the factors associated with colectomy in patients diagnosed with Clostridium difficile infection in a tertiary hospital in Mexico, in 2020. Methods: Observational, retrospective, and analytical study. We included records of patients with C. difficile infection who underwent to colectomy from March 2017 to June 2020 at a tertiary hospital Mexico City Dr. Bernardo Sepúlveda Gutiérrez Specialties Hospital. The following were evaluated: sex, age, personal history, biochemical (leukocyte, albumin and lactate levels, immunoassay of toxins A and B for C. difficile) and endoscopic imaging (pseudomembranes in the sigmoid rectum by rectosigmoidoscopy). Descriptive statistics, χ2 and odds ratio were used. Results: A total of 194 infected patients with C. difficile, 108 were women. Colectomy was performed in 36.10%; 58.57% were women and 70.00% were under 65 years of age. The more frequent comorbidity were nephropathy, heart disease, neurological and immunological diseases. The clinical features before surgery present in patients undergoing colectomy were ileus, abdominal pain, and more than six diarrheal evacuations in 24 hours. A total of 70 with colectomy 44 patients died. Conclusions: The risk of a patient undergoing colectomy as the last treatment option for patients with C. difficile infection is associated with different clinical variables of the disease, such as oral intolerance, organ failure, ileus, hypotension and fever, these in turn with the presence of comorbidity that in themselves cause immunocompromise. The altered biochemical tests frequently present in poor response to medical treatment in patients who underwent colectomy were leukocytosis > 15,000 cells/mm3, albumin < 3 g/dL, and lactate in venous blood gases < 2.2 mmol/dL.
Keywords: Clostridium difficile. Colectomy. Risk factors.
