{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:41:38Z","timestamp":1760060498111,"version":"build-2065373602"},"reference-count":33,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T00:00:00Z","timestamp":1757030400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background: Clostridium difficile colonization (CDC) represents a clinical concern in oncology patients undergoing abdominopelvic surgery, particularly regarding the potential role of prophylactic antibiotics in preventing progression to active infection. Methods: We performed a single-center, retrospective, case-matched observational study of oncology patients with CDC who underwent abdominopelvic surgery between 2018 and 2023. Patients were divided into two cohorts: those who received prophylactic antibiotics and those who did not. Postoperative outcomes were compared using propensity score matching (PSM). Logistic regression and ROC curve analysis were applied to assess the predictive value of antibiotics relative to other comorbidities. Results: Ninety patients were included (62 with antibiotics; 28 without). In the unmatched cohort, patients receiving antibiotics showed a non-significant trend toward higher morbidity (32.2% vs. 21.4%, p = 0.327) and surgical site infection rates (9.6% vs. 0%, p = 0.171). After PSM (26 patients per group), morbidity remained comparable between cohorts (30.7% vs. 23.0%, p = 0.538). Notably, no patient developed active C. difficile infection during follow-up, regardless of antibiotic use. Antibiotic therapy was not an independent predictor of postoperative morbidity (OR 1.746, p = 0.297; AUC 0.549, 95% CI 0.405\u20130.687). Conclusions: In this study, prophylactic antibiotic use in CDC patients undergoing abdominopelvic oncology surgery was not associated with improved postoperative outcomes. While no progression to active infection was observed, the potential benefits of prophylaxis remain uncertain. Larger, prospective studies are needed to clarify the clinical role of antibiotics in this setting.<\/jats:p>","DOI":"10.3390\/medicina61091606","type":"journal-article","created":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T12:18:18Z","timestamp":1757074698000},"page":"1606","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clostridium difficile Colonization in Oncologic Patients Undergoing Major Abdominopelvic Surgery: To Treat or Not to Treat? An Observational Study with Propensity Score Analysis"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9749-0610","authenticated-orcid":false,"given":"Sorinel","family":"Lunca","sequence":"first","affiliation":[{"name":"Department of Surgery, Grigore T Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), 700483 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wee Liam","family":"Ong","sequence":"additional","affiliation":[{"name":"Department of Surgery, Grigore T Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), 700483 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raluca","family":"Zaharia","sequence":"additional","affiliation":[{"name":"Department of Surgery, Grigore T Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), 700483 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Romulus Mihaita","family":"Pruna","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Regional Institute of Oncology (IRO), 700483 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriel Mihail","family":"Dimofte","sequence":"additional","affiliation":[{"name":"Department of Surgery, Grigore T Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), 700483 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7767-0975","authenticated-orcid":false,"given":"Stefan","family":"Morarasu","sequence":"additional","affiliation":[{"name":"Department of Surgery, Grigore T Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), 700483 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"105079","DOI":"10.1016\/j.cmicom.2025.105079","article-title":"Approach to Clostridioides difficile Diarrheal Infection","volume":"2","author":"Prosty","year":"2025","journal-title":"CMI Commun."},{"key":"ref_2","unstructured":"CDC (2025, August 02). C. diff: Facts for Clinicians. C. diff (Clostridioides difficile), Available online: https:\/\/www.cdc.gov\/c-diff\/hcp\/clinical-overview\/index.html."},{"key":"ref_3","first-page":"107785","article-title":"Clostridioides difficile Infection and Recurrence in Cancer Patients (CIRCA): A Multicentre, International Study","volume":"153","author":"Woolstencroft","year":"2025","journal-title":"Int. J. Infect. Dis. IJID Off. Publ. Int. Soc. Infect. Dis."},{"key":"ref_4","first-page":"266","article-title":"Clostridium difficile Infection in Oncology Patients: Epidemiology, Pathophysiology, Risk Factors, Diagnosis, and Treatment","volume":"46","author":"Abughanimeh","year":"2018","journal-title":"Hosp. Pract. 1995"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1715","DOI":"10.1001\/archinte.1992.00400200139025","article-title":"Clostridium difficile Diarrhea Induced by Cancer Chemotherapy","volume":"152","author":"Kamthan","year":"1992","journal-title":"Arch. Intern. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.amjsurg.2022.09.031","article-title":"Risk Factors for Clostridium difficile Infection in General Surgery Patients","volume":"225","author":"Hess","year":"2023","journal-title":"Am. J. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1002\/jso.27923","article-title":"Impact of Clostridium difficile Infection Versus Colonization on Postoperative Outcomes After Oncological Colorectal Surgery: An Observational Single-Center Study With Propensity Score Analysis","volume":"131","author":"Ong","year":"2025","journal-title":"J. Surg. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1503\/cmaj.110543","article-title":"The Effect of Hospital-Acquired Infection with Clostridium difficile on Length of Stay in Hospital","volume":"184","author":"Forster","year":"2012","journal-title":"CMAJ Can. Med. Assoc. J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1440","DOI":"10.1017\/ice.2019.277","article-title":"Clostridium difficile Infection Following Outpatient Cancer Surgery","volume":"40","author":"Cohen","year":"2019","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e65","DOI":"10.1017\/S0950268820000606","article-title":"Excess Length of Hospital Stay, Mortality and Cost Attributable to Clostridioides (Clostridium) difficile Infection and Recurrence: A Nationwide Analysis in Japan","volume":"148","author":"Kimura","year":"2020","journal-title":"Epidemiol. Infect."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"297","DOI":"10.7326\/0003-4819-117-4-297","article-title":"Treatment of asymptomatic Clostridium difficile carriers (fecal excretors) with vancomycin or metronidazole. A randomized, placebo-controlled trial","volume":"117","author":"Johnson","year":"1992","journal-title":"Ann Intern Med."},{"key":"ref_12","first-page":"280","article-title":"Clostridioides difficile infection: An update","volume":"32","author":"Salvati","year":"2024","journal-title":"Infez Med."},{"key":"ref_13","unstructured":"Mada, P.K., and Alam, M.U. (2025). Clostridioides difficile Infection. [Updated 10 April 2024]. StatPearls, StatPearls Publishing."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e179","DOI":"10.3346\/jkms.2025.40.e179","article-title":"Impact of Clostridium difficile Infection on Chemotherapy in Patients With Primary Ovarian Cancer","volume":"40","author":"Bae","year":"2025","journal-title":"J. Korean Med. Sci."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Ziegler, M.J., Anesi, J., Tolomeo, P., Glaser, L., Cowden, L., Cressman, L., Huang, E., Patel, A., Lautenbach, E., and Pegues, D.A. (2025). Screening and Targeted Prophylaxis for Clostridioides difficile Infection: STOP-CDI. Clin. Microbiol. Infect., Epub ahead of printing.","DOI":"10.1016\/j.cmi.2025.08.004"},{"key":"ref_16","first-page":"464","article-title":"Splenectomy Does Not Increase Early Morbidity in Patients Undergoing Total Gastrectomy: A Case-Control Study with Propensity Score Analysis","volume":"118","author":"Iacob","year":"2023","journal-title":"Chir. Buchar. Rom. 1990"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Lunca, S., Morarasu, S., Zaharia, R., Ivanov, A.-A., Clancy, C., O\u2019Brien, L., Ong, W.L., and Dimofte, G.-M. (2025). Can We Achieve More with Less? Parenchymal Sparing Surgery Versus Major Liver Resection for Colorectal Liver Metastases: An Observational Single\u2010Center Study with Propensity Score Analysis. Diagn, 15.","DOI":"10.3390\/diagnostics15111334"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/s13099-018-0259-4","article-title":"Gut Colonization with Vancomycin-Resistant Enterococcus and Risk for Subsequent Enteric Infection","volume":"10","author":"Axelrad","year":"2018","journal-title":"Gut Pathog."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1086\/592710","article-title":"Skin and Environmental Contamination with Vancomycin-Resistant Enterococci in Patients Receiving Oral Metronidazole or Oral Vancomycin Treatment for Clostridium Difficile-Associated Disease","volume":"30","author":"Sethi","year":"2009","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2403","DOI":"10.1128\/AAC.00090-08","article-title":"Both Oral Metronidazole and Oral Vancomycin Promote Persistent Overgrowth of Vancomycin-Resistant Enterococci during Treatment of Clostridium difficile-Associated Disease","volume":"52","author":"Sethi","year":"2008","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e00936-20","DOI":"10.1128\/mSphere.00936-20","article-title":"Randomized Controlled Trial of Oral Vancomycin Treatment in Clostridioides difficile-Colonized Patients","volume":"6","author":"Fishbein","year":"2021","journal-title":"mSphere"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e1001172","DOI":"10.1371\/journal.pmed.1001172","article-title":"Characterisation of Clostridium difficile Hospital Ward-Based Transmission Using Extensive Epidemiological Data and Molecular Typing","volume":"9","author":"Walker","year":"2012","journal-title":"PLoS Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e00021-17","DOI":"10.1128\/CMR.00021-17","article-title":"Understanding Clostridium Difficile Colonization","volume":"31","author":"Crobach","year":"2018","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1097\/DCR.0000000000000289","article-title":"Practice Parameters for the Management of Clostridium difficile Infection","volume":"58","author":"Steele","year":"2015","journal-title":"Dis. Colon Rectum"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"S154","DOI":"10.1097\/MCG.0b013e31822ec787","article-title":"Probiotics in Clostridium difficile Infection","volume":"45","author":"Na","year":"2011","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Gaisawat, M.B., MacPherson, C.W., Tremblay, J., Piano, A., Iskandar, M.M., Tompkins, T.A., and Kubow, S. (2019). Probiotic Supplementation in a Clostridium Difficile-Infected Gastrointestinal Model Is Associated with Restoring Metabolic Function of Microbiota. Microorganisms, 8.","DOI":"10.3390\/microorganisms8010060"},{"key":"ref_27","first-page":"1","article-title":"Guidelines for Clostridium difficile Infection in Adults","volume":"15","author":"Kukla","year":"2020","journal-title":"Przegl\u1015d Gastroenterol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1038\/ajg.2015.22","article-title":"Colonization with toxinogenic C. difficile upon hospital admission, and risk of infection: A systematic review and meta-analysis","volume":"110","author":"Zacharioudakis","year":"2015","journal-title":"Am. J. Gastroenterol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1093\/cid\/ciad142","article-title":"Natural History of Clostridioides difficile Colonization and Infection Following New Acquisition of Carriage in Healthcare Settings: A Prospective Cohort Study","volume":"77","author":"Curry","year":"2023","journal-title":"Clin. Infect. Dis."},{"key":"ref_30","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":"ref_31","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":"ref_32","doi-asserted-by":"crossref","first-page":"e1029","DOI":"10.1093\/cid\/ciab549","article-title":"Clinical Practice Guideline by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA): 2021 Focused Update Guidelines on Management of Clostridioides difficile Infection in Adults","volume":"73","author":"Johnson","year":"2021","journal-title":"Clin. Infect. Dis."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e1758","DOI":"10.1590\/0102-672020230040e1758","article-title":"Antibiotic prophylaxis for abdominal surgery: When to recommend? Brazilian college of digestive surgery position paper","volume":"36","author":"Freitas","year":"2023","journal-title":"ABCD Arq. Bras. Cir. Dig. S\u00e3o Paulo"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/9\/1606\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:40:09Z","timestamp":1760035209000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/9\/1606"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,5]]},"references-count":33,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["medicina61091606"],"URL":"https:\/\/doi.org\/10.3390\/medicina61091606","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2025,9,5]]}}}