Severe Clostridioides difficile Infection in the Intensive Care Unit-Medical and Surgical Management

Ramzy Husam Rimawi; Stephanie Busby; Wendy Ricketts Greene

doi:10.1016/j.idc.2022.07.006

Severe Clostridioides difficile Infection in the Intensive Care Unit-Medical and Surgical Management

Infect Dis Clin North Am. 2022 Dec;36(4):889-895. doi: 10.1016/j.idc.2022.07.006.

Authors

Ramzy Husam Rimawi¹, Stephanie Busby², Wendy Ricketts Greene³

Affiliations

¹ Department of Medicine, Division of Pulmonary, Sleep, Allergy, and Critical Care Medicine, Emory University School of Medicine, 550 Peachtree Street NorthWest, Atlanta, GA 30308, USA. Electronic address: RamzyRimawi@emory.edu.
² Department of Surgery, Emory University School of Medicine.
³ Emory University, Emory University Hospital, American College of Surgeons Board of Governors, SESC DEI Committee, ECCC IDEA Committee, Surgical Section of the NMA and Surgical Leaders Foundation, Emory School of Medicine African American Women's Collaborative.

PMID: 36328641
DOI: 10.1016/j.idc.2022.07.006

Abstract

Clostridioides difficile remains a major cause of morbidity and mortality in the intensive care unit, and therefore, C difficile guidelines are frequently being updated. Currently, fidaxomicin is the suggested treatment of initial and recurrent infection. Oral vancomycin is an acceptable alternative, followed by rifaximin and fecal microbiota transplantation. Bezlotoxumab is suggested in recurrent cases within 6 months. If patients fail to improve within 3 to 5 days of therapy, especially in patients who have had nasogastric tubes or emergent surgery, fulminant colitis is possible and surgical consultation should be considered for total colectomy.

Keywords: Clostridioides difficile; Colitis; Intensive care unit; Sepsis.

Publication types

Review

MeSH terms

Anti-Bacterial Agents / therapeutic use
Clostridioides difficile*
Clostridium Infections* / drug therapy
Fidaxomicin
Humans
Intensive Care Units

Substances

Anti-Bacterial Agents
Fidaxomicin