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Abstract：
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
UNASSIGNED: CRD42023484704.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
UNASSIGNED: CRD42023484704.
摘要：
背景：已经在造口逆转后的术后早期描述了艰难梭菌感染（CDI）。本系统评价旨在描述造口逆转后CDI的发生率，并确定与感染风险增加相关的术前变量。
方法：2024年3月根据PRISMA指南对文献进行了系统综述。如果报告至少一名患有CDI相关腹泻的患者在造口逆转（结肠造口术/回肠造口术）后，则包括手稿。感兴趣的主要结果是CDI的发生率；次要结果是临床变量的比较（年龄，性别,造口逆转的时间到了，索引结直肠手术后的新辅助和辅助治疗）CDI阳性与CDI阴性患者。当至少有三项研究报告了这些变量时，进行了荟萃分析。
结果：在43份合格手稿中，选择1项随机对照试验和10项回顾性研究,包括17,857例患者（2.1％CDI）。总的来说,CDI组的平均年龄为64.3±11.6岁，CDI阴性组的平均年龄为61.5±12.6岁（p=0.51），性别无显著差异(p=0.34)。单变量分析表明，CDI患者造口逆转的平均时间为53.9±19.1周，CDI阴性患者为39.8±15.0周（p=0.40），新辅助和CDI辅助治疗之间存在相关性（p<0.001）。对造口逆转的时间进行了荟萃分析，年龄,性别,和新辅助疗法显示CDI没有显着差异(造口延迟，MD11.59；95CI24.32-1.13；年龄，MD0.97；95CI2.08-4.03；性别，OR1.11;95CI0.88-1.41;新佐剂，OR0.81；95CI0.49-1.35）。包括接受辅助治疗的患者在内的荟萃分析显示CDI风险较高（OR2.88;95CI1.01-8.17，p=0.11）。
结论：约2.1%的患者在造口逆转后发生CDI。尽管CDI患者存在造口逆转延迟增加的趋势以及与化疗的相关性，使用辅助治疗是meta分析中记录的唯一可能的危险因素.
■CRD42023484704。
方法：2024年3月根据PRISMA指南对文献进行了系统综述。如果报告至少一名患有CDI相关腹泻的患者在造口逆转（结肠造口术/回肠造口术）后，则包括手稿。感兴趣的主要结果是CDI的发生率；次要结果是临床变量的比较（年龄，性别,造口逆转的时间到了，索引结直肠手术后的新辅助和辅助治疗）CDI阳性与CDI阴性患者。当至少有三项研究报告了这些变量时，进行了荟萃分析。
结果：在43份合格手稿中，选择1项随机对照试验和10项回顾性研究,包括17,857例患者（2.1％CDI）。总的来说,CDI组的平均年龄为64.3±11.6岁，CDI阴性组的平均年龄为61.5±12.6岁（p=0.51），性别无显著差异(p=0.34)。单变量分析表明，CDI患者造口逆转的平均时间为53.9±19.1周，CDI阴性患者为39.8±15.0周（p=0.40），新辅助和CDI辅助治疗之间存在相关性（p<0.001）。对造口逆转的时间进行了荟萃分析，年龄,性别,和新辅助疗法显示CDI没有显着差异(造口延迟，MD11.59；95CI24.32-1.13；年龄，MD0.97；95CI2.08-4.03；性别，OR1.11;95CI0.88-1.41;新佐剂，OR0.81；95CI0.49-1.35）。包括接受辅助治疗的患者在内的荟萃分析显示CDI风险较高（OR2.88;95CI1.01-8.17，p=0.11）。
结论：约2.1%的患者在造口逆转后发生CDI。尽管CDI患者存在造口逆转延迟增加的趋势以及与化疗的相关性，使用辅助治疗是meta分析中记录的唯一可能的危险因素.
■CRD42023484704。
