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Session:: ePosters-Sun800-M8: Benign Abdominal

EP333 - C. difficile Infection Following Ileostomy Reversal – Are Total Colectomy Patients at Higher Risk?

Sunday, May 10, 2026
8:21 AM - 8:26 AM ET

    ePoster Presenter(s)

  • Rebecca Kowalski, MD

    General Surgery Resident
    University of Maryland School of Medicine
    University of Maryland
    Baltimore, MD, United States

    Disclosure information not submitted.

    View ePoster

    • Author(s)

  • Amy VanderStoep, MD, MPH (she/her/hers)

    General Surgery Resident
    University of Maryland School of Medicine
    University of Maryland Medical Center
    Baltimore, MD, United States

    Disclosure information not submitted.

  • DM

    Diego A. Mora, n/a

    Medical Student
    University of Maryland School of Medicine
    Baltimore, Maryland, United States

    Disclosure information not submitted.

  • JG

    Joel Grunhut, MD

    Resident Physician
    University of Maryland
    Baltimore, Maryland, United States

    Disclosure information not submitted.

  • John J Newland, MD, MS

    Resident Physician
    University of Maryland
    University of Maryland
    Baltimore, MD, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • KL

    Kerri Lopez, MD

    Assistant Professor
    University of Maryland School of Medicine
    Baltimore, Maryland, United States

    All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

Purpose/Background: Compared to other surgical patients, those undergoing ileostomy reversal have an increased risk of Clostridioides difficile infection (CDI). Colonic mucosal atrophy and microbiota changes facilitated by prolonged diversion may further increase this risk. We aimed to explore risk factors for CDI development among ileostomy reversal patients, including whether the presence of residual colon impacted the risk of CDI development.

Methods/Interventions: A retrospective chart review was conducted of patients who underwent ileostomy reversal at a single academic institution between 01/2017-04/2025. CDI was defined as a positive C. difficile toxin followed by CDI treatment. Patients whose initial surgical indication was CDI were excluded. A subgroup analysis was conducted among patients with residual colon at the time of ileostomy reversal. Logistic regression was used to evaluate associations of CDI with potential risk factors including age, comorbidities, smoking status, history of CDI, type of stoma, residual colon, diversion duration, indication for resection, medication use, length of stay, and discharge disposition. Variables significant (p < 0.10) on bivariate analysis were included in multivariable analysis.

Results/Outcomes: Of the 312 post-reversal patients identified, CDI developed in 4.17% (n= 13) overall, and in 2.24% (n=7) within 90 days following reversal. Among the 75 patients who previously underwent total colectomy, CDI rate was 6.67% (n=5). The cohort was 37% female, with mean age 49yr, median diversion duration of 185 days (interquartile range 91-306), rarely had personal history of CDI (10%), and had ileostomies created in the settings of trauma (13%), cancer (29%), inflammatory bowel disease (24%), diverticulitis (10%), or other indications (23%).

None of the evaluated risk factors were statistically significantly associated with post-reversal CDI in the full cohort on bivariate analysis (Table 1). Subgroup bivariate analysis among patients with residual colon at time of ileostomy reversal demonstrated that post-reversal CDI odds were increased among patients with a history of CDI infection (odds ratio [OR] 5.9, 95% confidence interval [CI] 1.1-32.6, p=0.04), increasing length of stay (OR 1.04 per day, 95% CI 1.0-1.1, p=0.03), and who were not discharged home (e.g. to sub-acute rehab or skilled nursing facility) (OR 7.2, 95% CI 1.3-40.3, p=0.02). These associations were no longer statistically significant on multivariable analysis.

Conclusion/Discussion: Similar to reported rates in the literature, the CDI rate in this cohort of ileostomy reversal patients was 4.17%. Risk factors for CDI development after reversal may depend on the extent of residual colon. Notably, prior total colectomy patients demonstrated a trend toward a higher rate of CDI than patients with residual colon. Our analysis was limited by sample size; evaluation of these risk factors in post-reversal patients on a larger scale is needed.

Table 1. Bivariate Analysis Among All Patients and Residual Colon Subgroup