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

  • Massimo AntonelliEmail author
  • Ignacio Martin-Loeches
  • George Dimopoulos
  • Antonio Gasbarrini
  • Maria Sole Vallecoccia
Expert Statement
Part of the following topical collections:
  1. Severe infections in the critically ill


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.


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



Clostridioides difficile


Pseudomembranous colitis


Clostridioides difficile infection




European Centre for Disease Prevalence and Control


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


Community-acquired Clostridium difficile infection


Hospital-acquired Clostridium difficile infection


Non steroideal anti-inflammatory drugs


Proton pump inhibitors


Odds ratio


Confidence interval


H2 receptor antagonists


Stress ulcer prophylaxis


Randomized controlled trials


Intensive Care Unit


Nucleic acid amplification test


Enzyme-linked immunosorbent assay


Glutamate dehydrogenase


European society of clinical microbiology and infectious disease


Negative predictive value


Positive predictive value




Computed tomography


Infectious Diseases Society of America


Nasogastric tube


Fulminant Clostridioides difficile infection


Fecal microbiota transplantation


Multi-drug resistant




Author contributions

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.

Compliance with ethical standards

Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Supplementary material

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Supplementary material 1 (TIFF 2039 kb)
134_2019_5873_MOESM2_ESM.docx (2 mb)
Supplementary material 2 (DOCX 2086 kb)


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Authors and Affiliations

  1. 1.Department of Anesthesiology, Intensive Care and Emergency MedicineFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
  2. 2.Università Cattolica del Sacro CuoreRomeItaly
  3. 3.Department of Intensive Care MedicineMultidisciplinary Intensive Care Research Organization (MICRO), St. James’s HospitalDublinIreland
  4. 4.Hospital Clinic, IDIBAPS, Universidad de Barcelona, CiberesBarcelonaSpain
  5. 5.Critical Care Department, ATTIKON University Hospital, Medical SchoolNational and Kapodistrian University of AthensAthensGreece
  6. 6.Department of Internal Medicine and GastroenterologyFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly

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