Clinical Algorithms in General Surgery pp 241-242 | Cite as
Clostridium difficile Colitis
Abstract
Clostridium difficile colitis should be suspected in patients with watery foul-smelling diarrhea who have recently been hospitalized or exposed to antibiotics. Stool should be evaluated for C. difficile toxin to establish the diagnosis. Abdominal exam, white blood cells (WBC), and renal function should be used to determine the severity of infection. Patients with fulminant colitis, such as signs of systemic toxicity, should have a computed tomography (CT) scan to determine the extent of inflammation and dilation of the colon. If the colon is perforated, a total abdominal colectomy with end ileostomy should be performed. Management of mild disease is with metronidazole and per oral (PO) vancomycin for severe disease. Severe-complicated disease is treated with a combination of vancomycin PO and metronidazole IV and vancomycin enemas if ileus is suspected. Fecal transplant should be considered in patients with relapsing or refractory disease.
Keywords
Diarrhea C. difficile colitis Infectious colitis Vancomycin oral C. difficile toxin Fecal microbiota transplantReferences
- 1.Ananthakrishnan AN. Detecting and treating Clostridium difficile infections in patients with inflammatory bowel disease. Gastroenterol Clin N Am. 2012;41(2):339–53.CrossRefGoogle Scholar
- 2.Surawicz CM, Brandt LJ, Binion DG, Ananthakrishnan AN, Curry SR, Gilligan PH, et al. Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. Am J Gastroenterol. 2013;108(4):478–98. quiz 99CrossRefGoogle Scholar
- 3.Butala P, Divino CM. Surgical aspects of fulminant Clostridium difficile colitis. Am J Surg. 2010;200(1):131–5.CrossRefGoogle Scholar
- 4.Kaiser AM, Hogen R, Bordeianou L, Alavi K, Wise PE, Sudan R, et al. Clostridium difficile infection from a surgical perspective. J Gastrointest Surg. 2015;19(7):1363–77.CrossRefGoogle Scholar
- 5.Katzman M. Antibiotic therapy for Clostridium difficile infection. Semin Colon Rectal Surg. 2014;25(3):143–9.CrossRefGoogle Scholar
- 6.Lee CH, Steiner T, Petrof EO, Smieja M, Roscoe D, Nematallah A, et al. Frozen vs fresh fecal microbiota transplantation and clinical resolution of diarrhea in patients with recurrent Clostridium difficile infection: a randomized clinical trial. JAMA. 2016;315(2):142–9.CrossRefGoogle Scholar