Med. Surg. J. – Rev. Med. Chir. Soc. Med. Nat., Iaşi 2021, 125(1): 102-108 doi: 10.22551/MSJ.2021.01.13 SURGERY ORIGINAL PAPERS 102 WHAT GOES WRONG IN SURGICAL PATIENTS WITH CONCOMITANT CLOSTRIDIUM DIFFICILE INFECTION DISEASE? RISK FACTORS FOR IN-HOSPITAL MORTALITY Lidia Ionescu 1,2 , Roxana Maria Livadariu 1,2* , Irina Trifescu 1,2 , Ludmila Stirbu 1 , D. V. Timofte 1,2 , R. Danila 1,2 “Grigore T. Popa” University of Medicine and Pharmacy Iasi, Romania 1. Faculty of Medicine “Sf. Spiridon” County Clinical Emergency Hospital, Iasi, Romania 2. III rd Surgery Unit * Corresponding author. E-mail: roxanalivadariu@yahoo.com WHAT GOES WRONG IN SURGICAL PATIENTS WITH CONCOMITANT CLOSTRIDI- UM DIFFICILE INFECTION DISEASE? RISK FACTORS FOR IN-HOSPITAL MORTAL- ITY (Abstract) Aim: to evaluate the possible anthropometric, clinical, biological, and patho- logical factors that could be associated with an increased mortality of the surgical patients with concomitant CD infection. Material and methods: The study was carried out on a group of 123 surgical patients who were operated in the IIIrd Surgical Unit of the “Sf. Spiri- don” University Hospital Romania and were diagnosed with CDI during hospitalization. Re- sults: We noted 20 deaths among the patients from our study group. Characteristic for the deceased patient’s group was the presence of sepsis before or after CDI diagnosis (p = 0.001). The involving of a parenchymal organ (p = 0.001) and the presence of metastases (p = 0.025) were significantly higher in the deceased patient’s group. Reintervention induced an estimated risk of death approximately 2-fold higher (p = 0.002). The estimated risk of death was slightly higher in patients with renal chronic disease (p = 0.001), obesity (p = 0.009), Diabetes Mellitus (p = 0.005) and chronic cardiac insufficiency (p = 0.05). All pa- tients who died had surgical diseases requiring postoperative antibiotic treatment (p = 0.001) especially with Cephalosporin (p = 0.003) and Clindamycin (p = 0.047). The use of proton pump inhibitor and anticoagulant medication was statistically higher in patients who died. Conclusions: Unfavorable evolution of surgical patients with CDI is highly associated with obesity, renal chronic disease, chronic cardiac insufficiency, diabetes, chronic oral anticoag- ulants prior to CDI, treatment with third generation cephalosporin, clindamycin, and PPI af- ter surgery. Keywords: CLOSTRIDIUM DIFFICILE INFECTION, SURGICAL PATIENTS, MORTALITY IN SURGICAL PATIENTS WITH CD INFECTION. Clostridium difficile infection (CDI) is the most frequent nosocomial infection. Infection of the colon with the Gram-positive bacte- rium Clostridium difficile is potentially life threatening, especially in elderly people and in patients who have dysbiosis of the gut microbiota following antimicrobial drug exposure (1). There are some medical condi- tions, treatments and other factors that have already been demonstrated to increase the risk for CDI. Most important of those are sex, age, antibiotic treatment, and proton pump inhibitor (PPI) use, preexistent inflammatory bowel disease, healthcare facility contact and