Yao-Wen Cheng1, Monika Fischer2. 1. Division of Gastroenterology, Department of Medicine, University of San Francisco, San Francisco, CA, USA. 2. Division of Gastroenterology, Department of Medicine, Indiana University School of Medicine, 550 N. University Blvd, Suite 1602, Indianapolis, IN, 46202, USA. mofische@iu.edu.
Abstract
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.
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.
Authors: Christina M Surawicz; Lawrence J Brandt; David G Binion; Ashwin N Ananthakrishnan; Scott R Curry; Peter H Gilligan; Lynne V McFarland; Mark Mellow; Brian S Zuckerbraun Journal: Am J Gastroenterol Date: 2013-02-26 Impact factor: 10.864
Authors: Edward Krajicek; Monika Fischer; Jessica R Allegretti; Colleen R Kelly Journal: Clin Gastroenterol Hepatol Date: 2018-09-27 Impact factor: 11.382
Authors: Mark Miller; Denise Gravel; Michael Mulvey; Geoffrey Taylor; David Boyd; Andrew Simor; Michael Gardam; Allison McGeer; James Hutchinson; Dorothy Moore; Sharon Kelly Journal: Clin Infect Dis Date: 2010-01-15 Impact factor: 9.079