Antibiotic Regimen after a Total Abdominal Colectomy with Ileostomy for Fulminant<i>Clostridium difficile</i>Colitis: A Multi-Institutional Study

Wilden, Gwendolyn M. van der; Subramanian, Melanie P.; Chang, Yuchiao; Lottenberg, Lawrence; Sawyer, Robert G.; Davies, Stephen; Ferrada, Paula; Han, Jinfeng; Beekley, Alec C.; Velmahos, George C.; Moya, Marc A. de

doi:10.1089/sur.2013.153

Cited by 9 publications

(3 citation statements)

References 31 publications

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“…Potential underlying reasons for this are: (1) 100 mL is not adequate to reach the proximal colon; (2) a large enema volume may have a lavage effect on intracolonic toxin; and (3) the larger volume can introduce oxygen into the colonic lumen, which may perturb the anaerobic C. difficile, which is sensitive to even low levels of oxygen in the environment. However, a smaller volume (100 mL) may suffice for vancomycin instillation into a rectal stump after total abdominal colectomy for CDI [19].…”

Section: Discussionmentioning

confidence: 99%

Vancomycin Enema in the Treatment ofClostridium difficileInfection

Fawley

Napolitano

2019

Surgical Infections

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Background: Current guidelines for the treatment of Clostridium difficile infections (CDIs) recommend vancomycin enemas for patients with adynamic ileus. There is significant variability in guideline recommendations for vancomycin dose and enema volume and whether a retention enema should be used. The most recent (2017) guidelines from the Infectious Diseases Society of America/Society for Healthcare Epidemiology of America recommend rectal instillation of 500 mg of vancomycin in 100 mL of physiologic saline every 6 hours as a retention enema. Methods: Published studies regarding vancomycin enema use in CDI (1990-present) were reviewed to compare drug dose, volume, and whether a retention enema was used in order to determine the efficacy and make recommendations for optimal dosing. Results: Case series with higher vancomycin dose, higher enema volume, and use of retention enema demonstrated greater efficacy. Use of smaller volumes and lower doses (100 mL; 125-250 mg q 6 hours) demonstrated no efficacy of intracolonic vancomycin. Conclusion: We recommend revision of the current CDI guideline recommendations for patients with adynamic ileus to the following: Vancomycin per rectum (500 mg in a volume of 500 mL q 6 hours) by retention enema (18F Foley catheter with 30-cc balloon inserted into the rectum, balloon inflated, solution instilled, and catheter clamped for 60 minutes) for optimal efficacy.

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Section: Discussionmentioning

confidence: 99%

Vancomycin Enema in the Treatment ofClostridium difficileInfection

Fawley

Napolitano

2019

Surgical Infections

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“…Furthermore, multiple case reports have demonstrated successful medical management of severe CD colitis with crushed fidaxomicin through a nasogastric tube [11] , [12] . Since CD colitis is a toxin mediated disease, postoperative antibiotics are usually also recommended even in the cases of subtotal colectomy which should in theory provide mechanical source control [13] . Given the morbidity of a subtotal colectomy, there has recently been a push towards bowel sparing treatment regimens, most notably being loop ileostomy with intraoperative colonic lavage and 10 days of vancomycin antegrade washes [14] .…”

Section: Discussionmentioning

confidence: 99%

A case report of successful management of clostridium difficile colitis with antegrade Fidaxomicin through a mucous fistula obviating the need for subtotal colectomy

Arnott

Skancke

Chen

et al. 2018

International Journal of Surgery Case Reports

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“…Given the importance of rapid source control via TCEI for fulminant CDI, it is important to understand that continued management of any remaining infected colonic tissue must occur. In order to do this, current recommendations suggest 344 DELANO AND CUSCHIERI the use of oral and rectal vancomycin to eradicate any potential continued source of infection [25,26].…”

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confidence: 99%

Surgical Management ofClostridium difficileInfection: The Role of Colectomy

Delano

Cuschieri

2016

Surgical Infections

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Management of Clostridium difficile infections is usually accomplished through appropriate antimicrobial therapy. However, in patients that do not respond to this therapy, rapid and potentially lethal progressive organ dysfunction care occurs. Although supportive care and continued antimicrobial therapy is important, surgical therapy is critical to eradication of the inflammatory process and reversal of the dysregulated immunity associated with severe C. difficile infections. In the following paper, the role of colectomy is reviewed.

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Antibiotic Regimen after a Total Abdominal Colectomy with Ileostomy for FulminantClostridium difficileColitis: A Multi-Institutional Study

Abstract: Patients, after a TAC for fCDC, may be placed on either IV metronidazole or PO vancomycin depending upon local antibiograms, and proctitis may be treated with the addition of a vancomycin enema (PR). There was no data to support routine treatment of more than 7 d.

Cited by 9 publications

References 31 publications

Vancomycin Enema in the Treatment ofClostridium difficileInfection

Vancomycin Enema in the Treatment ofClostridium difficileInfection

A case report of successful management of clostridium difficile colitis with antegrade Fidaxomicin through a mucous fistula obviating the need for subtotal colectomy

Surgical Management ofClostridium difficileInfection: The Role of Colectomy

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