Evolving Strategies to Manage Clostridium difficile Colitis

  • Jessica A. Bowman
  • Garth H. UtterEmail author
Evidence-Based Current Surgical Practice


Clostridium difficile infection remains a common nosocomial illness with a significant impact on health care delivery. As molecular phenotyping of this organism has changed our understanding of its transmission and virulence, so too have diagnostic methods and treatment strategies evolved in recent years. The burden of this infection falls predominantly on elderly patients with comorbidities who have recently received antibiotics. Oral or enteral vancomycin is now preferred for first-line antimicrobial treatment across the disease spectrum, including mild-moderate initial cases. Fidaxomicin (a novel macrolide antibiotic), bezlotoxumab (a monoclonal antibody against toxin TcdB), and fecal microbiota transplantation expand the therapeutic armamentarium, particularly for recurrent infection. Operative treatment should be reserved for patients with fulminant infection, and early identification of patients who would benefit from an operation remains a challenge. Less invasive surgical options—such as laparoscopic diverting ileostomy with colonic irrigation—may improve survival and other outcomes relative to total abdominal colectomy and represent an attractive alternative particularly for frail patients.


Clostridium difficile colitis Pseudomembranous colitis 



Clostridium difficile infection


Proton pump inhibitor


Recurrent Clostridium difficile infection


Nucleic acid amplification test


Fecal microbiota transplant


National Surgical Quality Improvement Program


Gastrointestinal lavage


Funding Information

Dr. Bowman was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through grant #UL1 TR001860, and by the Agency for Healthcare Research and Quality through grant #T32HS022236.

Compliance with Ethical Standards


The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or AHRQ.

Disclosure Information

Dr. Utter reports non-financial support from the American Association for the Surgery of Trauma during the conduct of the study. Dr. Bowman does not report any.


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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of California, Davis, Medical CenterSacramentoUSA
  2. 2.Department of Surgery Outcomes Research Group (Utter)University of California, Davis, Medical CenterSacramentoUSA

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