{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T09:47:20Z","timestamp":1792057640816,"version":"4.4.0"},"reference-count":23,"publisher":"Cambridge University Press (CUP)","issue":"5","license":[{"start":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T00:00:00Z","timestamp":1772668800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S0899823X26104115_as1\">\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>\n                      <jats:italic>Clostridioides difficile<\/jats:italic>\n                      infection (CDI) requiring colectomy carries substantial mortality risk, with optimal timing of surgery remaining poorly defined. We examined temporal trends in colectomy among inpatients with CDI, identified predictors of surgical intervention and postoperative mortality, and evaluated the association between surgical timing and patient outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X26104115_as2\">\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A retrospective cohort study was conducted using the National Inpatient Sample database from 2018 to 2022. We compared patients undergoing colectomy with those managed medically. To minimize confounding by hospital-onset cases, the analysis of surgical timing and mortality was restricted to patients undergoing colectomy within 8 days of admission. Predictors were identified using survey-weighted logistic regression and LASSO regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X26104115_as3\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Among 240,564 CDI hospitalizations (representing 1,207,995 weighted nationally), 717 patients underwent colectomy (3,585 weighted). CDI prevalence declined from 0.99% (2018) to 0.76% (2022), while colectomy rates increased from 0.28% to 0.34%. Peritonitis (OR 5.42; 95% CI, 4.46\u20136.59), coagulopathy (OR 4.96; 95% CI, 3.76\u20136.55), and sepsis\/septic shock (OR 3.89; 95% CI, 3.39\u20134.47) were the strongest predictors of colectomy. Among patients undergoing colectomy within 8 days (2,830 weighted), in-hospital mortality was 26.5% overall, increasing from 21.0% (2018) to 30.7% (2022). Sepsis\/septic shock (OR 8.20; 95% CI 2.92\u201323.07) and coagulopathy (OR 7.27; 95% CI 3.31\u201315.97) predicted mortality. Each additional day from admission to colectomy was associated with a 16% (OR 1.16; 95% CI 1.04\u20131.28) increased mortality risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X26104115_as4\">\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In this nationally representative cohort, surgical timing was an independent and modifiable determinant of survival in patients with CDI requiring colectomy. Our findings underscore the importance of early surgical consultation for CDI patients with peritonitis, sepsis, and coagulopathy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/ice.2026.10411","type":"journal-article","created":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T10:54:06Z","timestamp":1772708046000},"page":"457-469","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Trends, predictors, and association of surgical timing with mortality among patients with\n                    <i>C<\/i>\n                    lostridioides difficile infection requiring colectomy: a cohort study"],"prefix":"10.1017","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4515-513X","authenticated-orcid":false,"given":"Zhengxi","family":"Chen","sequence":"first","affiliation":[{"name":"Case Western Reserve University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiuhan","family":"Li","sequence":"additional","affiliation":[{"name":"Johns Hopkins University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse","family":"Fajnzylber","sequence":"additional","affiliation":[{"name":"Mayo Clinic in Rochester"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1922-5555","authenticated-orcid":false,"given":"William M","family":"Patterson","sequence":"additional","affiliation":[{"name":"Johns Hopkins Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4919-4456","authenticated-orcid":false,"given":"James","family":"Townley","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04xv7je94","id-type":"ROR","asserted-by":"publisher"}],"name":"Alice L Walton School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5522-2995","authenticated-orcid":false,"given":"Abhishek","family":"Deshpande","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04xv7je94","id-type":"ROR","asserted-by":"publisher"}],"name":"Alice L Walton School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,3,5]]},"reference":[{"key":"S0899823X26104115_ref2","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1097\/DCR.0000000000002047","article-title":"The American society of colon and rectal surgeons clinical practice guidelines for the management of clostridioides difficile infection","volume":"64","author":"Poylin","year":"2021","journal-title":"Dis Colon Rectum"},{"key":"S0899823X26104115_ref10","doi-asserted-by":"crossref","first-page":"1501","DOI":"10.1002\/bjs.8868","article-title":"Systematic review and meta-analysis of outcomes following emergency surgery for clostridium difficile colitis","volume":"99","author":"Bhangu","year":"2012","journal-title":"Br J Surg"},{"key":"S0899823X26104115_ref5","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s13017-019-0228-3","article-title":"2019 Update of the WSES guidelines for management of clostridioides (Clostridium) difficile infection in surgical patients","volume":"14","author":"Sartelli","year":"2019","journal-title":"World J Emerg Surg"},{"key":"S0899823X26104115_ref6","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1186\/s13017-015-0033-6","article-title":"WSES guidelines for management of clostridium difficile infection in surgical patients","volume":"10","author":"Sartelli","year":"2015","journal-title":"World J Emerg Surg"},{"key":"S0899823X26104115_ref13","unstructured":"13. Healthcare Cost and Utilization Project (HCUP). Introduction To The HCUP National Inpatient Sample (NIS) 2022. Agency for Healthcare Research and Quality. 2024. https:\/\/hcup-us.ahrq.gov\/db\/nation\/nis\/NISIntroduction2022.pdf."},{"key":"S0899823X26104115_ref23","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1097\/DCR.0000000000001764","article-title":"Meta-analysis of postoperative mortality and morbidity after total abdominal colectomy versus loop ileostomy with colonic lavage for fulminant clostridium difficile colitis","volume":"63","author":"Felsenreich","year":"2020","journal-title":"Dis Colon Rectum"},{"key":"S0899823X26104115_ref21","doi-asserted-by":"crossref","first-page":"102050","DOI":"10.1016\/j.anaerobe.2019.06.003","article-title":"Changes in molecular epidemiology and antimicrobial resistance profiles of clostridioides (Clostridium) difficile strains in the United States between 2011 and 2017","volume":"60","author":"Tickler","year":"2019","journal-title":"Anaerobe"},{"key":"S0899823X26104115_ref9","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1097\/SLA.0b013e31828a8eba","article-title":"Predictors of mortality after emergency colectomy for clostridium difficile colitis: an analysis of ACS-NSQIP","volume":"259","author":"Lee","year":"2014","journal-title":"Ann Surg"},{"key":"S0899823X26104115_ref12","doi-asserted-by":"crossref","first-page":"2011","DOI":"10.1001\/jama.2017.17653","article-title":"Adherence to methodological standards in research using the national inpatient sample","volume":"318","author":"Khera","year":"2017","journal-title":"JAMA"},{"key":"S0899823X26104115_ref20","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1016\/j.jamcollsurg.2013.05.028","article-title":"Clostridium difficile colitis in the United States: a decade of trends, outcomes, risk factors for colectomy, and mortality after colectomy","volume":"217","author":"Halabi","year":"2013","journal-title":"J Am Coll Surg"},{"key":"S0899823X26104115_ref11","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1093\/cid\/ciy149","article-title":"Clinical practice guidelines for clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA)","volume":"66","author":"McDonald","year":"2018","journal-title":"Clin Infect Dis"},{"key":"S0899823X26104115_ref8","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1001\/archsurg.2007.46","article-title":"Predictors of mortality after colectomy for fulminant clostridium difficile colitis","volume":"143","author":"Byrn","year":"2008","journal-title":"Arch Surg"},{"key":"S0899823X26104115_ref15","unstructured":"15. Healthcare Cost and Utilization Project (HCUP). Elixhauser Comorbidity Software Rrfined For ICD-10-CM Diagnosis, v2025.1. Agency for Healthcare Research and Quality. 2024. https:\/\/hcup-us.ahrq.gov\/toolssoftware\/comorbidityicd10\/CMR-User-Guide-v2025-1.pdf."},{"key":"S0899823X26104115_ref1","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1186\/s12879-023-08096-0","article-title":"The burden of CDI in the United States: a multifactorial challenge","volume":"23","author":"Feuerstadt","year":"2023","journal-title":"BMC Infect Dis"},{"key":"S0899823X26104115_ref14","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1097\/00005650-199801000-00004","article-title":"Comorbidity measures for use with administrative data","volume":"36","author":"Elixhauser","year":"1998","journal-title":"Med Care"},{"key":"S0899823X26104115_ref22","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1001\/jamasurg.2019.2141","article-title":"Trends in diverting loop ileostomy vs total abdominal colectomy as surgical management for clostridium difficile colitis","volume":"154","author":"Juo","year":"2019","journal-title":"JAMA Surg"},{"key":"S0899823X26104115_ref18","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1016\/j.ajic.2020.09.010","article-title":"Impact of COVID-19 prevention measures on risk of health care-associated clostridium difficile infection","volume":"49","author":"Bentivegna","year":"2021","journal-title":"Am J Infect Control"},{"key":"S0899823X26104115_ref7","doi-asserted-by":"crossref","first-page":"1484","DOI":"10.1097\/TA.0000000000000232","article-title":"Timing and type of surgical treatment of clostridium difficile-associated disease: a practice management guideline from the Eastern Association for the Surgery of Trauma","volume":"76","author":"Ferrada","year":"2014","journal-title":"J Trauma Acute Care Surg"},{"key":"S0899823X26104115_ref17","doi-asserted-by":"crossref","first-page":"1748","DOI":"10.1093\/cid\/ciab688","article-title":"The impact of coronavirus disease 2019 (COVID-19) on healthcare-associated infections","volume":"74","author":"Baker","year":"2022","journal-title":"Clin Infect Dis"},{"key":"S0899823X26104115_ref4","doi-asserted-by":"crossref","first-page":"2177","DOI":"10.1001\/archinte.162.19.2177","article-title":"The spectrum of pseudomembranous enterocolitis and antibiotic-associated diarrhea","volume":"162","author":"Hurley","year":"2002","journal-title":"Arch Intern Med"},{"key":"S0899823X26104115_ref3","doi-asserted-by":"crossref","first-page":"1124","DOI":"10.14309\/ajg.0000000000001278","article-title":"ACG clinical guidelines: prevention, diagnosis, and treatment of clostridioides difficile infections","volume":"116","author":"Kelly","year":"2021","journal-title":"Am J Gastroenterol"},{"key":"S0899823X26104115_ref19","doi-asserted-by":"crossref","first-page":"ofac441","DOI":"10.1093\/ofid\/ofac441","article-title":"Prevalence and health outcomes of clostridioides difficile infection during the coronavirus disease 2019 Pandemic in a National Sample of United States hospital systems","volume":"9","author":"Reveles","year":"2022","journal-title":"Open Forum Infect Dis"},{"key":"S0899823X26104115_ref16","doi-asserted-by":"crossref","first-page":"1320","DOI":"10.1056\/NEJMoa1910215","article-title":"Trends in U.S. Burden of clostridioides difficile infection and outcomes","volume":"382","author":"Guh","year":"2020","journal-title":"N Engl J Med"}],"container-title":["Infection Control &amp; Hospital Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0899823X26104115","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T09:12:03Z","timestamp":1792055523000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0899823X26104115\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,5]]},"references-count":23,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["S0899823X26104115"],"URL":"https:\/\/doi.org\/10.1017\/ice.2026.10411","relation":{},"ISSN":["0899-823X","1559-6834"],"issn-type":[{"value":"0899-823X","type":"print"},{"value":"1559-6834","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,5]]},"assertion":[{"value":"\u00a9 The Author(s), 2026. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}