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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

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.

Keywords

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

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

Notes

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

134_2019_5873_MOESM1_ESM.tiff (2 mb)
Supplementary material 1 (TIFF 2039 kb)
134_2019_5873_MOESM2_ESM.docx (2 mb)
Supplementary material 2 (DOCX 2086 kb)

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© Springer-Verlag GmbH Germany, part of Springer Nature 2020

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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