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Clostridioides difficile (formerly Clostridium difficile) infection in the critically ill: an expert statement

Abstract

Clostridioides difficile (formerly Clostridium difficile) infection (CDI) represents a worrisome condition, often underestimated, with severe clinical presentations, frequently requiring intensive care unit (ICU) admission. The aim of the present expert statement was to give an overview of the management of CDI in critically ill patients, for whom CDI represents a redoubtable problem, in large part related to the use and abuse of antibiotics. The available knowledge about pathophysiology, risk factors, diagnosis and treatment concerning critical care patients affected by CDI has been reviewed, even though most of the existing information come from studies performed outside the ICU and the evidence on several issues in this specific context is scarce. The adoption of potential preventive and therapeutic strategies aimed to stem the phenomenon were discussed, including the faecal microbiota transplantation. This possibility could represent a highly interesting option in critically ill patients, but current evidence is limited and future well designed studies are needed. A special insight on the specific challenges that the ICU physicians may face caring for the critically ill patients with CDI was also proposed.

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Abbreviations

CD:

Clostridioides difficile

PMC:

Pseudomembranous colitis

CDI:

Clostridioides difficile infection

RT:

Ribotype

ECDC:

European Centre for Disease Prevalence and Control

EUCLID:

European, multicenter, prospective, biannual, point-prevalence study of CDI in hospitalized patients with diarrhea

CA-CDI:

Community-acquired Clostridium difficile infection

HA-CDI:

Hospital-acquired Clostridium difficile infection

NSAIDs:

Non steroideal anti-inflammatory drugs

PPIs:

Proton pump inhibitors

OR:

Odds ratio

CI:

Confidence interval

H2RAs:

H2 receptor antagonists

SUP:

Stress ulcer prophylaxis

RCTs:

Randomized controlled trials

ICU:

Intensive Care Unit

NAAT:

Nucleic acid amplification test

ELISA:

Enzyme-linked immunosorbent assay

GDH:

Glutamate dehydrogenase

ESCMID:

European society of clinical microbiology and infectious disease

NPV:

Negative predictive value

PPV:

Positive predictive value

PMs:

Pseudomembranes

CT:

Computed tomography

IDSA:

Infectious Diseases Society of America

NGT:

Nasogastric tube

FCDI:

Fulminant Clostridioides difficile infection

FMT:

Fecal microbiota transplantation

MDR:

Multi-drug resistant

COX:

Cyclooxygenase

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MA conceived the idea for the article. MA, IML, GD, AG and MSV drafted the manuscript. MA and MSV took care of the editing and supervised the work. MA, IML, GD, AG and MSV read and approved the final version.

Correspondence to Massimo Antonelli.

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Antonelli, M., Martin-Loeches, I., Dimopoulos, G. et al. Clostridioides difficile (formerly Clostridium difficile) infection in the critically ill: an expert statement. Intensive Care Med (2020). https://doi.org/10.1007/s00134-019-05873-x

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Keywords

  • Clostridium difficile
  • Clostridioides difficile
  • Burden of Clostridioides difficile infection
  • Critically ill patients
  • Treatment
  • Fecal microbiota transplantation