{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T13:13:45Z","timestamp":1762866825061},"reference-count":19,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2016,5,3]],"date-time":"2016-05-03T00:00:00Z","timestamp":1462233600000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2016,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p><jats:italic>Clostridium difficile<\/jats:italic> infection (<jats:styled-content style=\"fixed-case\">CDI<\/jats:styled-content>) of the ileal pouch following restorative proctocolectomy (<jats:styled-content style=\"fixed-case\">RPC<\/jats:styled-content>) is becoming increasingly recognized. We aimed to understand better (i) the associated risk factors, (ii) treatment practices and (iii) the pouch diversion and failure rate in patients who developed <jats:styled-content style=\"fixed-case\">CDI<\/jats:styled-content> of the pouch after <jats:styled-content style=\"fixed-case\">RPC<\/jats:styled-content> for ulcerative colitis (<jats:styled-content style=\"fixed-case\">UC<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Patients who tested positive for <jats:italic>C.\u00a0difficile<\/jats:italic> of the pouch between 2007 and 2010 were included in the analysis. Data collected included patient demographics, time from <jats:styled-content style=\"fixed-case\">RPC<\/jats:styled-content> to documented <jats:styled-content style=\"fixed-case\">CDI<\/jats:styled-content>, the\u00a0treatment of <jats:styled-content style=\"fixed-case\">CDI<\/jats:styled-content> and rate of excision of the pouch.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 2785 patients recorded in the hospital <jats:styled-content style=\"fixed-case\">CDI<\/jats:styled-content> database, 15 had had an <jats:styled-content style=\"fixed-case\">RPC<\/jats:styled-content> with ileal pouch anal anastomosis. The median age was 44\u00a0years and the median interval from <jats:styled-content style=\"fixed-case\">RPC<\/jats:styled-content> to first documented episode of <jats:styled-content style=\"fixed-case\">CDI<\/jats:styled-content> was 3\u00a0years. Thirteen (81%) patients had had multiple episodes of pouchitis before and after <jats:styled-content style=\"fixed-case\">CDI<\/jats:styled-content> infection, and all were symptomatic at the time of testing for <jats:styled-content style=\"fixed-case\">CDI<\/jats:styled-content>. Within 30\u00a0days of the diagnosis of <jats:styled-content style=\"fixed-case\">CDI<\/jats:styled-content>, six (40%) patients were taking immunosuppressive medication, seven (47%) were taking a proton pump inhibitor and 12 (80%) had received antibiotics. Five patients required hospitalization for <jats:styled-content style=\"fixed-case\">CDI<\/jats:styled-content> and four had severe infections characterized by a serum creatinine more than 1.5 times baseline (<jats:italic>n\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>3) and a white cell count above 15\u00a0000 (<jats:italic>n\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>1). Six patients who underwent endoscopy had severe inflammation of the pouch including the presence of a pseudomembrane in one case. Ten patients were treated with metronidazole alone and five with vancomycin. Two patients had recurrent <jats:styled-content style=\"fixed-case\">CDI<\/jats:styled-content> of the pouch during a median follow\u2010up period of 2.9\u00a0years and one had <jats:styled-content style=\"fixed-case\">CDI<\/jats:styled-content> refractory to medical management. This patient required diversion of the pouch with an ileostomy for refractory <jats:styled-content style=\"fixed-case\">CDI<\/jats:styled-content> but no patient required excision of the pouch.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>All 15 patients developing <jats:styled-content style=\"fixed-case\">CDI<\/jats:styled-content> of the pouch were successfully treated with antibiotics and only one required surgery in the form of an ileostomy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/codi.13325","type":"journal-article","created":{"date-parts":[[2016,3,6]],"date-time":"2016-03-06T11:34:43Z","timestamp":1457264083000},"update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["<i>Clostridium difficile<\/i> infection after restorative proctocolectomy and ileal pouch anal anastomosis for ulcerative colitis"],"prefix":"10.1111","volume":"18","author":[{"given":"M. L.","family":"Martinez Ugarte","sequence":"first","affiliation":[{"name":"Division of Colon and Rectal Surgery Mayo Clinic Rochester Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. L.","family":"Lightner","sequence":"additional","affiliation":[{"name":"Division of Colon and Rectal Surgery Mayo Clinic Rochester Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D.","family":"Colibaseanu","sequence":"additional","affiliation":[{"name":"Division of Colon and Rectal Surgery Mayo Clinic Rochester Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Khanna","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Mayo Clinic Rochester Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D. S.","family":"Pardi","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Mayo Clinic Rochester Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E. J.","family":"Dozois","sequence":"additional","affiliation":[{"name":"Division of Colon and Rectal Surgery Mayo Clinic Rochester Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K. L.","family":"Mathis","sequence":"additional","affiliation":[{"name":"Division of Colon and Rectal Surgery Mayo Clinic Rochester Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,5,3]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/ibd.20278"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10350-008-9194-7"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2008.02.021"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0b013e3182417358"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.crohns.2008.09.003"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/914303"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2014.22"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/MIB.0000000000000205"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2011.12.003"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2012.179"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2012.108"},{"key":"e_1_2_7_13_1","doi-asserted-by":"crossref","first-page":"E214","DOI":"10.1177\/000313481107701101","article-title":"Clostridium difficile pouchitis after proctocolectomy with ileal pouch\u2212anal anastomosis","volume":"77","author":"Pricolo VE","year":"2011","journal-title":"Am Surg"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/18.6.982"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/MIB.0b013e318280fcb9"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-006-9172-7"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10350-004-6533-1"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2008.12.038"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir404"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-013-1771-0"}],"container-title":["Colorectal Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fcodi.13325","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/codi.13325","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,14]],"date-time":"2023-09-14T04:08:25Z","timestamp":1694664505000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/codi.13325"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,5]]},"references-count":19,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2016,5]]}},"alternative-id":["10.1111\/codi.13325"],"URL":"https:\/\/doi.org\/10.1111\/codi.13325","archive":["Portico"],"relation":{},"ISSN":["1462-8910","1463-1318"],"issn-type":[{"value":"1462-8910","type":"print"},{"value":"1463-1318","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,5]]},"assertion":[{"value":"2015-12-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-02-05","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-05-03","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}