The Risk Factors of Clostridium difficile Colitis in Colorectal Surgery

obstruction symptoms, the incidence of C. difficile infection has been reported to be increased to 29% [2]. In geriatric patients who have received colorectal surgery, the cause of the development of C. difficile colitis is thought to be the deterioration of host immune system, nonetheless, more comprehensive mechanisms are a subject to study. The reason that oral metronidazole is favored over erythromycin in preoperative treatments is because it effectively reduces C. difficile proliferation [2]. As risk factors for C. difficile colitis developed after intestinal surgery, albumin value, prothrombin time, duration of cephalosporin and aminoglycoside injection, the duration of the use of antacid, transfusion volume, intraperitoneal abscess, fasting period, and the duration in the intensive care unit have been reported to be significant [1]. Numerous investigators consider the purpose of the use of prophylactic antibiotics prior to surgery as primarily the prevention of surgical wound infection or sepsis and other complications, and the complications such as C. difficile colitis may be considered as incidental complications. Most C. difficile colitis is cured after conservative treatments. Nonetheless, it has been reported that in severe cases, retention enema using vancomycin was attempted [3]. When planned colorectal surgeries are performed, if mechanical bowel irrigation is performed prior to surgery for the prevention of perioperative infection, intravenous injection of antibiotics once is sufficient [4]. C. difficile colitis is a complication that may develop after colorectal operation in geriatric patients, patients with suppressed immunity, and patients associated with bowel obstruction. The frequency is up to 21% [2]. Once developed, the morbidity and mortality are high, and financial loss is large, and thus best efforts should be made for its prevention and early detection. Therefore, studies to develop the standard bowel irrigation method that could achieve the purpose without causing the rapid change of the intestinal bacterial flora as well as studies on the selection of ideal antibiotics should be conducted continuously.