Early colectomy may be associated with improved survival in fulminant Clostridium difficile colitis: an 8-year experience

Seder, Christopher W.; Robbins, James M.; Ivascu, Felicia A.; Carpenter, Christopher; Dietrich, Mary Ruth; Villalba, Mario

doi:10.1016/j.amjsurg.2008.11.001

Cited by 68 publications

(50 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These findings were echoed in the largest reported retrospective study of 73 patients undergoing colectomy for PMC, which on multivariate analysis concluded that preoperative changes in mental status and vasopressor requirement significantly predicted mortality [113]. The same study also found that length of medical treatment prior to surgical intervention was a significant predictor of mortality which supports the assertion made by many authors of the need for early surgical intervention in these patients [110,111,114,121,124].…”

Section: Risk Factors For Mortality Following Surgical Interventionsupporting

confidence: 60%

Review of medical and surgical management of Clostridium difficile infection

Faris

Blackmore

Haboubi³

2010

Tech Coloproctol

View full text Add to dashboard Cite

Clostridium difficile infection (CDI) has become an important area in our daily clinical practice. C. difficile is known to cause a broad spectrum of conditions ranging from asymptomatic carriage, through mild or moderately severe disease with watery diarrhoea, to the life-threatening pseudomembranous colitis (PMC), with toxic megacolon and ileus. Peoples who have been treated with broad-spectrum antibiotics, patients with serious underlying co-morbidities and the elderly are at greatest risk. Over 80% of CDIs reported are in people aged over 65. Due to the alarming increase in its frequency, appearance of more virulent strains and occasional need for life-saving surgical intervention, a more coherent multidisciplinary approach is needed. Combination of rapid turn round time and accurate diagnosis will result in a better management of CDI and a timely implementation of infection control measure. Discontinuation of causative agents such as antibiotic treatment is often curative. In more serious cases, oral administration of metronidazole or vancomycin is the treatment of choice. Relapses of CDI have been reported in about 20-25% of cases, this may increase to 45-60% after the first recurrence. Patients should be treated as soon as possible when the diagnosis of Clostridium difficile colitis is made to avoid sepsis or bowel perforation. Colectomy may improve the outcome of the patient with systemic or complicated Clostridium difficile colitis. This article reviews the changing epidemiological picture, microbiology, histopathology and both medical and surgical managements.

show abstract

Section: Risk Factors For Mortality Following Surgical Interventionsupporting

confidence: 60%

Review of medical and surgical management of Clostridium difficile infection

Faris

Blackmore

Haboubi³

2010

Tech Coloproctol

View full text Add to dashboard Cite

show abstract

“…It is therefore recommended that a surgical consultation be obtained early if a patient has worsening diarrhea despite optimal medical therapy, symptoms of megacolon, or sepsis. [109][110][111] AN APPROACH TO TREATMENT OF RECURRENT CDI A major problem in management of CDI is recurrent infection, which occurs in 20% to 25% of patients after the first episode of CDI. 4,7 Risk factors for recurrent CDI are given in Table 3.…”

Section: Fecal Microbiota Transplantationmentioning

confidence: 99%

Clostridium difficile Infection: New Insights Into Management

Khanna

Pardi

2012

Mayo Clinic Proceedings

123

113

View full text Add to dashboard Cite

Clostridium difficile was first described as a cause of diarrhea in 1978 and is now among the leading 3 hospital-acquired infections in the United States, along with methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci. In the past 2 decades, there has been an increase in the incidence, severity, and recurrence rates of C difficile infection, all of which are associated with poor outcomes. In addition, several novel risk factors and newer treatment methods are emerging, including fidaxomicin therapy, treatment using monoclonal antibodies, and fecal microbiota transplantation, that have shown promise for the treatment of C difficile infection. This review focuses on the changing epidemiology, risk factors, and newer methods for treatment of C difficile infection.

show abstract

“…An extra focus was the addition of a rectal enema of vancomycin to the antibiotic regimen. Overall, patients who received an enema in addition to IV/PO vancomycin or metronidazole had a longer ICU LOS (median [IQR] of 11 d [6][7][8][9][10][11][12][13][14][15][16][17][18][19] vs. 5 d [2][3][4][5][6][7][8][9][10][11], p = 0.001), and a greater incidence of proctitis (13.9% vs. 0, p = 0.006). When stratified by time interval, adding an enema to any antibiotic regimen of £ 7 days was associated with a delay to full enteral feeds (median [IQR] of 6 d [5][6][7] vs. 3 d [2.5-4], p = 0.047).…”

Section: Resultsmentioning

confidence: 99%

“…Our primary outcome, mortality, was 26% (26/100) overall. The median (IQR) HLOS was 19 d (11-37), with a median ICU LOS of 6.5 d (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15), and median ventilator-free days of 25 (0-27). All other variables, including the intra-and postoperative status, as well as the complications that occurred, can be found in Table 1.…”

Section: Resultsmentioning

confidence: 99%