Evolving Strategies to Manage Clostridium difficile Colitis
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.
KeywordsClostridium 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
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.
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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