Impact of Emergency Colectomy on Survival of Patients With Fulminant Clostridium difficile Colitis During an Epidemic Caused by a Hypervirulent Strain

Lamontagne, François; Labbé, Annie‐Claude; Haeck, Olivier; Lesur, Olivier; Lalancette, Mathieu; Patiño, Carlos; Leblanc, Martine; Laverdière, Michél; Pépin, Jacques

doi:10.1097/01.sla.0000236628.79550.e5

Cited by 323 publications

(237 citation statements)

References 21 publications

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“…Independent risk factors for mortality in patients who underwent colectomy that have been found consistently among multiple studies include the development of shock, as determined by the need for vasopressors, and increased lactate ( ≥ 5 mmol / l), mental status changes, end organ failure, renal failure, and the need for preoperative intubation and ventilation ( 39,43,65,74 ).…”

Section: Management Of Rcdimentioning

confidence: 95%

“…Th e vague term " clinical deterioration " is frequently mentioned in already critically ill patients in whom medical therapy has failed. Th ese strategies rely on surgery as a salvage therapy, which may account for the poor outcomes associated with subtotal colectomy in complicated CDI, and mortality rates that range from 35 % to 80 % ( 38,39,41,42,65,72 ). It has become evident that surgery is of benefi t to patients at the advanced extreme of CDI, and early surgical consultation has been associated with improved survival.…”

Section: Management Of Rcdimentioning

confidence: 99%

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Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Surawicz

Brandt

Binion

et al. 2013

American Journal of Gastroenterology

1,457

1,408

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Clostridium diffi cile infection (CDI) is a leading cause of hospital-associated gastrointestinal illness and places a high burden on our health-care system. Patients with CDI typically have extended lengths-of-stay in hospitals, and CDI is a frequent cause of large hospital outbreaks of disease. This guideline provides recommendations for the diagnosis and management of patients with CDI as well as for the prevention and control of outbreaks while supplementing previously published guidelines. New molecular diagnostic stool tests will likely replace current enzyme immunoassay tests. We suggest treatment of patients be stratifi ed depending on whether they have mild-to-moderate, severe, or complicated disease. Therapy with metronidazole remains the choice for mildto-moderate disease but may not be adequate for patients with severe or complicated disease. We propose a classifi cation of disease severity to guide therapy that is useful for clinicians. We review current treatment options for patients with recurrent CDI and recommendations for the control and prevention of outbreaks of CDI. Am J Gastroenterol 2013; 108:478-498; doi: 10.1038/ajg.2013 12. In patients in whom oral antibiotics cannot reach a segment of the colon, such as with Hartman's pouch, ileostomy, or colon diversion, vancomycin therapy delivered via enema should be added to treatments above until the patient improves. (Conditional recommendation, low-quality evidence)13. The use of anti-peristaltic agents to control diarrhea from confi rmed or suspected CDI should be limited or avoided, as they may obscure symptoms and precipitate complicated disease. Use of anti-peristaltic agents in the setting of CDI must always be accompanied by medical therapy for CDI. (Strong recommendation, low-quality evidence) Management of severe and complicated CDI14. Supportive care should be delivered to all patients and includes intravenous fl uid resuscitation, electrolyte replacement, and pharmacological venous thromboembolism prophylaxis. Furthermore, in the absence of ileus or signifi cant abdominal distention, oral or enteral feeding should be continued. 17. Vancomycin delivered orally (500 mg four times per day) and per rectum (500 mg in a volume of 500 ml four times a day) plus intravenous metronidazole (500 mg three times a day) is the treatment of choice for patients with complicated CDI with ileus or toxic colon and / or signifi cant abdominal distention. (Strong recommendation, low-quality evidence)18. Surgical consult should be obtained in all patients with complicated CDI. Surgical therapy should be considered in patients with any one of the following attributed to CDI: hypotension requiring vasopressor therapy; clinical signs of sepsis and organ dysfunction (renal and pulmonary); mental status changes; white blood cell count ≥ 50,000 cells / μ l, lactate ≥ 5 mmol / l; or failure to improve on medical therapy after 5 days. (Strong recommendation, moderate-quality evidence) Management of recurrent CDI (RCDI)19. The fi rst recurrence of CDI can be treated ...

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Section: Management Of Rcdimentioning

confidence: 95%

Section: Management Of Rcdimentioning

confidence: 99%

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Surawicz

Brandt

Binion

et al. 2013

American Journal of Gastroenterology

1,457

1,408

View full text Add to dashboard Cite

show abstract

“…However, despite all clinical advances, the current overall mortality rate for fulminant CDI is ~ 50 % , which is only a modest improvement over that seen in 1958. 6 Fortunately, most cases of CDI present with mild or moderate diarrhea rather than with severe illness, and the majority of patients can be treated with metronidazole or vancomycin. However, ~ 20 % of these cases suff er recurrence of the infection, and the risk of recurrence increases twofold with each successive episode.…”

Section: A Khoruts 1 and Mj Sadowskymentioning

confidence: 99%

Therapeutic transplantation of the distal gut microbiota

Khoruts

Sadowsky

2011

Mucosal Immunology

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“…3,9 In addition, the survival rate was higher among patients without multiorgan failure, compared with those who experienced multiorgan failure 9 ; APACHE II and III scores were higher among nonsurvivors, compared with survivors. 3,10 A lactate level higher than 5 mmol/L was associated with increased mortality. 10 Thus, we believe that in addition to the grading system developed by Dubberke et al, 5 one also needs to factor in the above-mentioned clinical, hemodynamic, and laboratory parameters when assessing the severity of CDAD.…”

Section: Reasonmentioning

confidence: 99%

“…3,10 A lactate level higher than 5 mmol/L was associated with increased mortality. 10 Thus, we believe that in addition to the grading system developed by Dubberke et al, 5 one also needs to factor in the above-mentioned clinical, hemodynamic, and laboratory parameters when assessing the severity of CDAD.…”

Section: Reasonmentioning

confidence: 99%

Is Diarrhea Enough to Assess the Severity of Clostridium difficile–Associated Disease?

Jaber

Reeves

Couperus

2008

Infect. Control Hosp. Epidemiol.

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Impact of Emergency Colectomy on Survival of Patients With Fulminant Clostridium difficile Colitis During an Epidemic Caused by a Hypervirulent Strain

Abstract: Emergency colectomy reduces mortality in some patients with fulminant CDAD.

Cited by 323 publications

References 21 publications

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Therapeutic transplantation of the distal gut microbiota

Is Diarrhea Enough to Assess the Severity of Clostridium difficile–Associated Disease?

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