European Society of Clinical Microbiology and Infectious Diseases: Update of the Treatment Guidance Document for Clostridium difficile Infection

Abstract

In 2009 the first European Society of Clinical Microbiology and Infection (ESCMID) treatment guidance document for Clostridium difficile infection (CDI) was published. The guideline has been applied widely in clinical practice. In this document an update and review on the comparative effectiveness of the currently available treatment modalities of CDI is given, thereby providing evidence-based recommendations on this issue. A computerized literature search was carried out to investigate randomized and non-randomized trials investigating the effect of an intervention on the clinical outcome of CDI. The Grades of Recommendation Assessment, Development and Evaluation (GRADE) system was used to grade the strength of our recommendations and the quality of the evidence. The ESCMID and an international team of experts from 11 European countries supported the process. To improve clinical guidance in the treatment of CDI, recommendations are specified for various patient groups, e.g. initial non-severe disease, severe CDI, first recurrence or risk for recurrent disease, multiple recurrences and treatment of CDI when oral administration is not possible. Treatment options that are reviewed include: antibiotics, toxin-binding resins and polymers, immunotherapy, probiotics, and faecal or bacterial intestinal transplantation. Except for very mild CDI that is clearly induced by antibiotic usage antibiotic treatment is advised. The main antibiotics that are recommended are metronidazole, vancomycin and fidaxomicin. Faecal transplantation is strongly recommended for multiple recurrent CDI. In case of perforation of the colon and/or systemic inflammation and deteriorating clinical condition despite antibiotic therapy, total abdominal colectomy or diverting loop ileostomy combined with colonic lavage is recommended.

Recruitment of feces donors among blood donors: Results from an observational cohort study

“…Currently, FMT is a recommended and highly efficacious treatment for recurrent Clostridium difficile infections (RCDI), 1 , 2 and promising results from previous studies indicate that FMT may have beneficial effects in diseases such as ulcerative colitis (UC), irritable bowel syndrome (IBS), and systemic infections with antibiotic-resistant bacteria (ARB). 3-6 …”

Clostridium difficile Infection

“…1d), toxic megacolon (severe dilatation of the colon), bowel perforation and sepsis, and/or multiple organ dysfunction syndrome 14,132,153 . Given that the characteristics (for example, age, use of medication or underlying comorbidities) of patients who can acquire CDI are highly variable, there is considerable variation in the possible severity assessments for this disease, which is reflected in the differing criteria used in guidelines 154,155 . Severe diarrhoea associated with C. difficile is often accompanied by a typical endoscopic picture of pseudomembranous colitis with haemorrhage and deep ulcerations.…”

“…Several reviews and guidelines for controlling CDI have been published 154,155,157,[191][192][193][194][195] . Although some differences exist, most of these guidelines have similar recommendations (BOX 3).…”

“…Multiple risk factors for recurrent CDI have been suggested in the literature, but as not all of these are evident at the time of treatment initiation, it is difficult to select appropriate parameters. Age >65 years, concomitant antibiotics, renal failure, history of previous CDI, possibly continued use of antacid medications and initial disease severity 155,204 are associated with increased risk of recurrence. …”

Treatment of Clostridium difficile infection: a national survey of clinician recommendations and the use of faecal microbiota transplantation

“…difficile infection (CDI) is characterised by reductions in microbial diversity of the complex gut microbiota, and stool transplantation from healthy donors (faecal microbiota transplantation, FMT) is increasingly recommended for treatment of patients with recurrent CDI. 1,2 CDI is a mandatory notifiable infection under Irish public health legislation. In 2014, 155/1613 (8.5%) of cases were classified as recurrent CDI (i.e.…”