The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Clostridioides difficile Infection

Poylin, Vitaliy; Hawkins, Alexander T.; Bhama, Anuradha R.; Boutros, Marylise; Lightner, Amy L.; Khanna, Sahil; Paquette, Ian M.; Feingold, Daniel L.; Surgeons, Rectal

doi:10.1097/dcr.0000000000002047

Cited by 8 publications

(26 citation statements)

References 251 publications

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“…The publication dates of the included guidelines ranged from 2017 to 2021. Seven of them used the GRADE grading system ( Mullish et al., 2018 ; Abreu et al., 2019 ; Sartelli et al., 2019 ; Kelly et al., 2021 ; Poylin et al., 2021 ; Johnson et al., 2021 ; Lewis et al., 2021 ). One of them used the OCEBM grading system ( Baunwall et al., 2021 ), and the other guidelines do not mention the grading of evidence ( Crobach et al., 2018 ; Mullane et al., 2019 ; Antonelli et al., 2020 ; Gnocchi et al., 2020 ; Piekarska et al., 2020 ; Xu et al., 2020 ).…”

Section: Resultsmentioning

confidence: 99%

“…One of them used the OCEBM grading system ( Baunwall et al., 2021 ), and the other guidelines do not mention the grading of evidence ( Crobach et al., 2018 ; Mullane et al., 2019 ; Antonelli et al., 2020 ; Gnocchi et al., 2020 ; Piekarska et al., 2020 ; Xu et al., 2020 ). One of the published guidelines was from Mexico ( Abreu et al., 2019 ), one was from Germany ( Antonelli et al., 2020 ), one was from the Netherlands ( Crobach et al., 2018 ), one was from Italy ( Gnocchi et al., 2020 ), one was from Poland ( Piekarska et al., 2020 ), one was Danish ( Baunwall et al., 2021 ), one was Chinese ( Xu et al., 2020 ), one was developed by international organizations ( Sartelli et al., 2019 ), two were British ( Mullish et al., 2018 ; Lewis et al., 2021 ), and four were American ( Mullane et al., 2019 ; Kelly et al., 2021 ; Poylin et al., 2021 ; Johnson et al., 2021 ). Eight of these guidelines were original versions ( Crobach et al., 2018 ; Mullish et al., 2018 ; Abreu et al., 2019 ; Antonelli et al., 2020 ; Piekarska et al., 2020 ; Xu et al., 2020 ; Baunwall et al., 2021 ; Poylin et al., 2021 ), and six guidelines were updated from the original guidelines ( Mullane et al., 2019 ; Sartelli et al., 2019 ; Gnocchi et al., 2020 ; Kelly et al., 2021 ; Johnson et al., 2021 ; Lewis et al., 2021 ).…”

Section: Resultsmentioning

confidence: 99%

“…It is important to note that there are two guidelines with relative scores exceeding 40% in each domain, which were developed by ASCRS ( Poylin et al., 2021 ) and NICE ( Lewis et al., 2021 ). Four guidelines have overall evaluation scores greater than 60% ( Mullish et al., 2018 ; Poylin et al., 2021 ; Johnson et al., 2021 ; Lewis et al., 2021 ), these guidelines are recommended, and nine guidelines have overall evaluation scores between 30 and 60% ( Abreu et al., 2019 ; Mullane et al., 2019 ; Sartelli et al., 2019 ; Antonelli et al., 2020 ; Gnocchi et al., 2020 ; Piekarska et al., 2020 ; Xu et al., 2020 ; Baunwall et al., 2021 ; Kelly et al., 2021 ), which are in the recommended category but still need improvement. There is one guideline with a total score of less than 30% ( Crobach et al., 2018 ), which is not recommended.…”

Section: Resultsmentioning

confidence: 99%

“…Fortunately, the situation has been highly prioritized by researchers around the world. In recent years, many guidelines on how to diagnose and treat CDI have been developed ( Crobach et al., 2018 ; Mullish et al., 2018 ; Abreu et al., 2019 ; Mullane et al., 2019 ; Sartelli et al., 2019 ; Antonelli et al., 2020 ; Gnocchi et al., 2020 ; Piekarska et al., 2020 ; Xu et al., 2020 ; Baunwall et al., 2021 ; Johnson et al., 2021 ; Kelly et al., 2021 ; Lewis et al., 2021 ; Poylin et al., 2021 ); however, the methodological quality of the guidelines is unclear, and they also vary widely regarding the items of diagnosis and treatment of CDI, which leads to confusion among guideline users. Therefore, the goal of this study is to analyse the methodological quality of current guidelines for the diagnosis and treatment of CDI using the AGREE II tool, reveal the heterogeneity of each guideline in the recommendations for the diagnosis and treatment of CDI, discuss the potential causes of this heterogeneity, help researchers and clinicians select the most appropriate guidelines and recommendations, and provide a better reference basis for guideline developers.…”

Section: Introductionmentioning

confidence: 99%

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Systematic review of guidelines for the diagnosis and treatment of Clostridioides difficile infection

Yang

et al. 2022

Front. Cell. Infect. Microbiol.

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ObjectiveTo systematically assess the current related methodological quality of guidelines for the diagnosis and treatment of Clostridioides difficile infection (CDI), revealing the heterogeneity and reasons for guideline recommendations for the diagnosis and treatment of CDI.MethodsWe searched electronic databases systematically between 2017 and 2021 to find the latest guidelines for the diagnosis and treatment of CDI. The Appraisal of Guidelines for Research and Evaluation (AGREE II) tool was used for quality assessment of the included guidelines. The main recommendations for the diagnosis and treatment of CDI in the guidelines were extracted and evaluated for consistency, and the level of evidence supporting these recommendations was further extracted and analysed.ResultsFourteen guidelines for the diagnosis and treatment of CDI were finally included in this study. There were four guidelines, BSG and HIS, ASCRS, IDSA AND SHEA, and NICE, with an overall score of more than 60%, which is worthy of clinical recommendation. Further analysis of the consistency of the main recommendations for the diagnosis and treatment of CDI in the guidelines showed that the recommendations differed among guidelines. There are no unified classification criteria for the severity of CDI in current studies; some recommendations for the diagnosis and treatment of CDI do not provide evidence to support the recommendations, most recommendations cite low levels of evidence, and there is a lack of high-quality research evidence.ConclusionThe quality of guidelines for the diagnosis and treatment of CDI is uneven. Recommendations on the diagnosis and treatment of CDI have also varied in the guidelines for the past 5 years. Improvements of the aforementioned factors associated with causing heterogeneity would be a rational approach by guideline developers to further update guidelines for the diagnosis and treatment of CDI.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Systematic review of guidelines for the diagnosis and treatment of Clostridioides difficile infection

Yang

et al. 2022

Front. Cell. Infect. Microbiol.

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“…Bezlotoxumab proved to be efficient in reducing the incidence of recurrent CDI in IBD patients [ 137 ]. Recent guidelines included Bezlotoxumab 10 mg/kg infusion as an adjunct treatment in high-risk patients, for initial or recurrent severe CDI [ 138 ].…”

Section: Treatment Strategiesmentioning

confidence: 99%

The Current Knowledge on Clostridioides difficile Infection in Patients with Inflammatory Bowel Diseases

et al. 2022

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Clostridioides difficile (C. difficile) represents a major health burden with substantial economic and clinical impact. Patients with inflammatory bowel diseases (IBD) were identified as a risk category for Clostridioides difficile infection (CDI). In addition to traditional risk factors for C. difficile acquisition, IBD-specific risk factors such as immunosuppression, severity and extension of the inflammatory disease were identified. C. difficile virulence factors, represented by both toxins A and B, induce the damage of the intestinal mucosa and vascular changes, and promote the inflammatory host response. Given the potential life-threatening complications, early diagnostic and therapeutic interventions are required. The screening for CDI is recommended in IBD exacerbations, and the diagnostic algorithm consists of clinical evaluation, enzyme immunoassays (EIAs) or nucleic acid amplification tests (NAATs). An increased length of hospitalization, increased colectomy rate and mortality are the consequences of concurrent CDI in IBD patients. Selection of CD strains of higher virulence, antibiotic resistance, and the increasing rate of recurrent infections make the management of CDI in IBD more challenging. An individualized therapeutic approach is recommended to control CDI as well as IBD flare. Novel therapeutic strategies have been developed in recent years in order to manage severe, refractory or recurrent CDI. In this article, we aim to review the current evidence in the field of CDI in patients with underlying IBD, pointing to pathogenic mechanisms, risk factors for infection, diagnostic steps, clinical impact and outcomes, and specific management.

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Surgical Management Options in Severe C Difficile Colitis

Ammann,

Paquette

2023

Difficult Decisions in Colorectal Surgery

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The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Clostridioides difficile Infection

Cited by 8 publications

References 251 publications

Systematic review of guidelines for the diagnosis and treatment of Clostridioides difficile infection

Systematic review of guidelines for the diagnosis and treatment of Clostridioides difficile infection

The Current Knowledge on Clostridioides difficile Infection in Patients with Inflammatory Bowel Diseases

Surgical Management Options in Severe C Difficile Colitis

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