Clostridium difficile in the ICU

Abstract

Clostridium diffi cile infection (CDI) management has become more daunting over the past decade because of alarming increases in CDI incidence and severity both in the hospital and in the community. This increase has concomitantly caused signifi cant escalation of the health-care economic burden caused by CDI, and it will likely be translated to increased ICU admission and attributable mortality. Some possible causes for diffi culty in management of CDI are as follows: (1) inability to predict and prevent development of severe/complicated or relapsing CDI in patients who initially present with mild symptoms; (2) lack of a method to determine who would have benefi ted a priori from initiating vancomycin treatment fi rst instead of treatment with metronidazole; (3) lack of sensitive and specifi c CDI diagnostics; (4) changing epidemiology of CDI, including the emergence of a hypervirulent, epidemic C diffi cile strain associated with increased morbidity and mortality; (5) association of certain high-usage nonantimicrobial medications with CDI; and (6) lack of treatment regimens that leave the normal intestinal fl ora undisturbed while treating the primary infection. The objective of this article is to present current management and prevention guidelines for CDI based on recommendations

Clostridium difficile Colitis in Patients Undergoing Lower-extremity Arthroplasty: Rare Infection With Major Impact

“…In nonorthopaedic patient populations, increased age has been associated with C difficile infection [26,31]. It has been suggested that increased age serves as a marker of increased comorbidities and exposure encounters in the hospital setting [4]. It is possible, due to the advanced age of patients presenting for lower-extremity arthroplasty, there may be a selection bias favoring an older population without substantial variation in age between patients with or without C difficile colitis.…”

“…due to suppression of normal gut bacterial flora by routine antibiotics, creating an opportunity for subsequent infection and proliferation of C difficile and its associated cytotoxins and enterotoxins [3]. Colonization with C difficile often occurs in the hospital setting with administration of antibiotics [4] that disturb flora in the intestinal tract. Two studies [16,24] suggest incidence and associated mortality of C difficile colitis are increasing, most notably in patients undergoing surgical procedures [34].…”

Clostridium difficile in the ICU

“…Mild disease consists of crampy, watery diarrhea without systemic symptoms. This cohort constitutes 70% of patients with C. difficile infection as only about 30% of patients with C. difficile infection are febrile and 50% have a leukocytosis [48]. In severe disease, fecal leukocytes are generally high and diagnosis can be confirmed with endoscopy demonstrating pseudomembranous colitis.…”

“…The four comorbidities that place patients at greatest risk are sepsis, pneumonia, urinary tract infections, and skin infections-all of which generally require antibiotics for treatment. Patients hospitalized with higher numbers of conditions are more likely to contract C. difficile infection than patients with fewer conditions [48]. More recently, it has been noted that peripartum women and infants also appear to be at increased risk for C. difficile infection, including severe C. difficile infection related to the epidemic BI/NAP1/027 strain [62,63].…”

Improving patient safety in perioperative care for major surgeries

“…A normális baktériumfl óra pusztulásának egyik kiváltó tényezője az ellátás során alkalmazott antibiotikus kezelés. Az antimikrobás szerek által okozott pseudomembranosus colitis kialakulásáért 90%-ban fl uorokinilonok, cefalosporinok és clindamycin tehetők felelőssé, ezért ezen szerek különösen fokozott fi gyelemmel alkalmazandók [24]. A túlzott antibiotikum-használat kedvez a multirezisztens törzsek elterjedésének is, amelyet saját, magyarországi adataink is megerősítenek.…”