Laparotomy for Fulminant Pseudomembranous Colitis

Medich, David S.; Lee, Kenneth K.W.; Simmons, Richard L.; Grubbs, Philip E.; Yang, Harold C.; Showalter, David P.

doi:10.1001/archsurg.1992.01420070111020

Cited by 77 publications

(40 citation statements)

References 15 publications

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“…Survival of patients treated with segmental colectomy were worse than those treated with subtotal colectomy ( 41,76,77 ), likely because CDI usually involves the entire colon. Intraoperative assessment of the extent of disease is diffi cult based upon the external appearance of the colon from the serosal surface.…”

Section: Management Of Rcdimentioning

confidence: 98%

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

Surawicz

Brandt

Binion

et al. 2013

American Journal of Gastroenterology

1,467

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: 98%

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

Surawicz

Brandt

Binion

et al. 2013

American Journal of Gastroenterology

1,467

1,408

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“…C. difficile was identified by Hall and O'Toole abdominal pain (80-90%) [5,21,22,[51][52][53][54][55][56]. The severity of diarrhea may vary from mild diarrhea that resolves as [24] in 1935.…”

Section: Historical Background and General Aspectsmentioning

confidence: 99%

“…PMC was originally associated with bowel movements a day. Symptoms may last several months without appropriate therapy [17,18,20,51,52]. various noninfectious etiologies including heavy metal intoxication, sepsis, shock, uremia, colonic obstruction, and ischemic cardiovascular insufficiency [3,11,19,26].…”

Section: Historical Background and General Aspectsmentioning

confidence: 99%

“…This is clinically important since proctoscopy alone may not detect these changes [10,17,21,65,68,[70][71][72]. Flexible sigmoidoscopy should be cautiously performed to confirm the diagnosis of PMC in all patients only exception is a toxic patient where high risk for perforation may exist as the disease progresses [52,[67][68][69][74][75][76][77]. Besides collecting tissue for culture assays or histology, decompression after assessment may be considor other inflammatory entities in patients with diarrhea, ered if abdominal distension is present [51,68,76,77].…”

Section: Endoscopymentioning

confidence: 99%

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<i>Clostridium difficile </i>Infection: Risk Factors, Medical and Surgical Management

Klingler¹,

Metzger²,

Seelig³

et al. 2000

Dig Dis

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Background:Clostridium difficile has become recognized as a cause of nosocomial infection which may progress to a fulminant disease. Methods: Literature review using electronic literature research back to 1966 utilizing Medline and Current Contents. All publications on antibiotic-associated diarrhea, antibiotic-associated colitis, and pseudomembranous colitis as well as C. difficile infection were included. We addressed established and potential risk factors for C. difficile disease such as an impaired immune system and cost benefits of different diagnostic tests. An algorithm is outlined for diagnosis and both medical and surgical management of mild, moderate and severe C. difficile disease. Results: Diagnosis of C. difficile infection should be suspected in patients with diarrhea, who have received antibiotics within 2 months or whose symptoms started after hospitalization. A stool specimen should be tested for the presence of leukocytes and C. difficile toxins. If this is negative and symptoms persist, stool should be tested with ‘rapid’ enzyme immunoabsorbent and stool cytotoxin assays, which are the most cost-effective tests. Endoscopy and other imaging studies are reserved for severe and rapidly progressive courses. Oral metronidazole or vancomycin are the antibiotics of choice. Surgery is rarely required for selected patients refractory to medical treatment. The threshold for surgery in severe cases with risk factors including an impaired immune system should be low. Conclusion:C. difficile infection has been recognized with increased frequency as a nosocomial infection. Early diagnosis with immunoassays of the stool and prompt medical therapy have a high cure rate. Metronidazole has supplanted oral vancomycin as the drug of first choice for treating C. difficile infections.

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“…In large series, 0.4%-3.6% of patients have required surgery, with an overall mortality of 30%-80% [133][134][135] . Series of severe CDI repeatedly emphasize how difficult the diagnosis may be.…”

Section: Surgical Interventionmentioning

confidence: 99%

Clinical update for the diagnosis and treatment ofClostridium difficileinfection

Oldfield

Johnson

2014

WJGPT

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Clostridium difficile infection (CDI) presents a rapidly evolving challenge in the battle against hospitalacquired infections. Recent advances in CDI diagnosis and management include rapid changes in diagnostic approach with the introduction of newer tests, such as detection of glutamate dehydrogenase in stool and polymerase chain reaction to detect the gene for toxin production, which will soon revolutionize the diagnostic approach to CDI. New medications and multiple medical society guidelines have introduced changing concepts in the definitions of severity of CDI and the choice of therapeutic agents, while rapid expansion of data on the efficacy of fecal microbiota transplantation heralds a revolutionary change in the management of patients suffering multiple relapses of CDI. Through a comprehensive review of current medical literature, this article aims to offer an intensive review of the current state of CDI diagnosis, discuss the strengths and limitations of available laboratory tests, compare both current and future treatments options and offer recommendations for best practice strategies.

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Laparotomy for Fulminant Pseudomembranous Colitis

Cited by 77 publications

References 15 publications

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

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

<i>Clostridium difficile </i>Infection: Risk Factors, Medical and Surgical Management

Clinical update for the diagnosis and treatment ofClostridium difficileinfection

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