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Fulminant Clostridium difficile colitis.

Sasha D Adams1, David W Mercer

  • 1Department of Surgery, University of Texas Medical School at Houston, Houston, Texas 77030, USA.

Current Opinion in Critical Care
|June 30, 2007
PubMed
Summary
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Fulminant Clostridium difficile colitis can be lethal, occurring in 3-8% of patients. Early colectomy before vasopressor use may improve survival in severe cases of this infectious diarrhea.

Area of Science:

  • Infectious Diseases
  • Gastroenterology
  • Critical Care Medicine

Background:

  • Clostridium difficile infection (CDI) is a leading cause of nosocomial diarrhea in adults.
  • CDI is increasingly recognized for its rising incidence and virulence.
  • While often indolent, CDI can progress to life-threatening fulminant colitis.

Purpose of the Study:

  • To enhance awareness of the potential lethality of Clostridium difficile infection, particularly fulminant colitis.
  • To review the epidemiology, pathogenesis, and treatment strategies for CDI.
  • To emphasize the critical management of fulminant C. difficile colitis.

Main Methods:

  • This is a review article, synthesizing existing literature on Clostridium difficile infection.
  • Emphasis is placed on the clinical presentation and management of fulminant colitis.

Related Experiment Videos

  • Epidemiological data, pathogenesis insights, and therapeutic options are discussed.

    • Main Results:

    • Fulminant colitis complicates 3-8% of CDI cases.
    • Early indicators of severe disease include immunosuppression, hypotension, hypoalbuminemia, and leukocytosis.
    • Prompt colectomy prior to vasopressor therapy is associated with improved survival in fulminant CDI.

    Conclusions:

    • The incidence and virulence of CDI are increasing, linked to antibiotic use and hospital stay duration.
    • Metronidazole is the recommended first-line therapy, with antibiotic stewardship crucial.
    • Fulminant colitis, occurring in 3-8% of patients, may present without diarrhea and often requires subtotal colectomy; early surgical intervention is advised for patients with marked leukocytosis or bandemia.