Treatment of Severe and Fulminnant Clostridioides difficile Infection

  • Yao-Wen Cheng
  • Monika FischerEmail author
Gastroenterology for Geriatric Patients (S Katz and A Afzali, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Gastroenterology for Geriatric Patients


Purpose of review

This article will review current management strategies for severe and fulminant Clostridioides difficile infection (CDI).

Recent findings

Clostridioides difficile is the most common nosocomial cause of infectious diarrhea. With the rise of hypervirulent strains of CDI, almost 8% of patients hospitalized with CDI are afflicted with severe CDI (SCDI) or fulminant CDI (FCDI). A significant proportion of these patients do not respond to recommended anti-CDI antibiotic therapy such as oral vancomycin and fidaxomicin. Current recommendations suggest that patients with refractory CDI should proceed to colectomy or diverting loop ileostomy with colonic lavage. However, both of these surgical interventions result in high rates of post-surgical mortality approaching 30%. Fecal microbiota transplantation (FMT) is a promising therapy that is recommended in recurrent CDI. Recent studies have found that FMT can safely produce cure rates between 70 and 90% in patients with SCDI and FCDI, while significantly decreasing rates of CDI-related mortality and colectomy. A patient population likely to benefit the most from FMT is elderly patients due to their increased risk for CDI, treatment failure, and high comorbidity burden that may preclude surgical intervention.


FMT should be considered in patients with SCDI or FCDI particularly when traditional anti-CDI antibiotics are ineffective.


Fecal microbiota transplantation Elderly Aged Clostridioides difficile Inflammatory bowel disease Colonoscopy 


Compliance with ethical standards

Conflict of interest

Yao-Wen Cheng declares that he has no conflict of interest. Monika Fischer declares that she has no conflict of interest.

Human and animal rights and informed consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as:• Of importance ••Of major importance

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Authors and Affiliations

  1. 1.Division of Gastroenterology, Department of MedicineUniversity of San FranciscoSan FranciscoUSA
  2. 2.Division of Gastroenterology, Department of MedicineIndiana University School of MedicineIndianapolisUSA

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