Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of the Sacred Hearth, Largo Francesco Vito 1, 00168, Rome, Italy.
Catholic University of the Sacred Hearth, Rome, Italy.
Int J Colorectal Dis. 2024 May 29;39(1):81. doi: 10.1007/s00384-024-04643-6.
Clostridium difficile infection (CDI) has been described in the early post-operative phase after stoma reversal. This systematic review aimed to describe the incidence of CDI after stoma reversal and to identify pre-operative variables correlated with an increased risk of infection.
A systematic review of the literature was conducted according to the PRISMA guidelines in March 2024. Manuscripts were included if reported at least one patient with CDI-associated diarrhoea following stoma reversal (colostomy/ileostomy). The primary outcome of interest was the incidence of CDI; the secondary outcome was the comparison of clinical variables (age, sex, time to stoma reversal, neo-adjuvant and adjuvant therapies after index colorectal procedure) in CDI-positive versus CDI-negative patients. A meta-analysis was performed when at least three studies reported on those variables.
Out of 43 eligible manuscripts, 1 randomized controlled trial and 10 retrospective studies were selected, including 17,857 patients (2.1% CDI). Overall, the mean age was 64.3 ± 11.6 years in the CDI group and 61.5 ± 12.6 years in the CDI-negative group (p = 0.51), with no significant difference in sex (p = 0.34). Univariable analyses documented that the mean time to stoma reversal was 53.9 ± 19.1 weeks in CDI patients and 39.8 ± 15.0 weeks in CDI-negative patients (p = 0.40) and a correlation between neo-adjuvant and adjuvant treatments with CDI (p < 0.001). A meta-analysis was performed for time to stoma reversal, age, sex, and neo-adjuvant therapies disclosing no significant differences for CDI (stoma delay, MD 11.59; 95%CI 24.32-1.13; age, MD 0.97; 95%CI 2.08-4.03; sex, OR1.11; 95%CI 0.88-1.41; neo-adjuvant, OR0.81; 95%CI 0.49-1.35). Meta-analysis including patients who underwent adjuvant therapy evidenced a higher risk of CDI (OR 2.88; 95%CI 1.01-8.17, p = 0.11).
CDI occurs in approximately 2.1% of patients after stoma reversal. Although a trend of increased delay in stoma reversal and a correlation with chemotherapy were documented in CDI patients, the use of adjuvant therapy was the only possible risk factor documented on meta-analysis.
CRD42023484704.
据报道，在造口还纳术后的早期术后阶段会发生艰难梭菌感染（CDI）。本系统评价旨在描述造口还纳术后 CDI 的发生率，并确定与感染风险增加相关的术前变量。
按照 PRISMA 指南，于 2024 年 3 月对文献进行系统评价。如果报告了至少 1 例与造口还纳后 CDI 相关的腹泻的患者，则纳入研究。主要结局为 CDI 的发生率；次要结局为 CDI 阳性与 CDI 阴性患者的临床变量（年龄、性别、造口还纳时间、指数结直肠手术后的新辅助和辅助治疗）比较。当至少有 3 项研究报告这些变量时，进行了荟萃分析。
在 43 篇合格的论文中，选择了 1 项随机对照试验和 10 项回顾性研究，共纳入 17857 例患者（2.1% CDI）。总体而言，CDI 组的平均年龄为 64.3±11.6 岁，CDI 阴性组为 61.5±12.6 岁（p=0.51），性别无显著差异（p=0.34）。单变量分析记录了 CDI 患者的造口还纳时间为 53.9±19.1 周，CDI 阴性患者为 39.8±15.0 周（p=0.40），新辅助和辅助治疗与 CDI 之间存在相关性（p<0.001）。对造口还纳时间、年龄、性别和新辅助治疗进行荟萃分析，结果显示 CDI 无显著差异（造口延迟，MD 11.59；95%CI 24.32-1.13；年龄，MD 0.97；95%CI 2.08-4.03；性别，OR1.11；95%CI 0.88-1.41；新辅助治疗，OR0.81；95%CI 0.49-1.35）。包括接受辅助治疗的患者的荟萃分析表明，CDI 的风险更高（OR 2.88；95%CI 1.01-8.17，p=0.11）。
在造口还纳术后，约有 2.1%的患者发生 CDI。尽管在 CDI 患者中记录到造口还纳时间延迟的趋势和与化疗的相关性，但辅助治疗的使用是荟萃分析中记录到的唯一可能的危险因素。
CRD42023484704。
