Surgical Management of Clostridium difficile Colitis

Clostridium difficile infection (CDI) will progress to fulminant disease in 3 to 5% of cases. With the emergence of hypervirulent, multidrug-resistant strains, the incidence and severity of disease are continuing to rise. Prompt identification, early resuscitation, and treatment are critical in preventing morbidity and mortality in this increasingly common condition. Discontinuation of antibiotics and treatment with oral vancomycin and intravenous or oral metronidazole are first-line treatments, but complicated cases may require surgery. Subtotal colectomy with ileostomy remains the standard of care when toxic megacolon, perforation, or an acute surgical abdomen is present, but mortality rates are high. Recognition of risk factors for fulminant CDI and earlier surgical intervention may decrease mortality from this highly lethal disease.