Clostridioides difficile (formerly Clostridium difficile) infection in the critically ill: an expert statement

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Microbiology

Background:

• Clostridioides difficile infection (CDI) presents severe clinical challenges, frequently necessitating intensive care unit (ICU) admission.
• Antibiotic use and overuse are significant contributors to the high incidence and severity of CDI, particularly in vulnerable patient populations.
• Existing research on CDI management primarily focuses on non-ICU settings, leaving a knowledge gap for critically ill patients.

Purpose of the Study:

• To provide an expert overview of Clostridioides difficile infection management in critically ill patients.
• To review current knowledge on the pathophysiology, risk factors, diagnosis, and treatment of CDI in the ICU setting.
• To discuss potential preventive and therapeutic strategies, including fecal microbiota transplantation, for CDI in critical care.

Main Methods:

• Systematic review of available literature on Clostridioides difficile infection in critically ill patients.
• Expert consensus and statement formulation based on reviewed evidence.
• Analysis of challenges faced by ICU physicians in managing CDI.

Main Results:

• Evidence regarding CDI management in ICUs is scarce, with most data originating from non-ICU studies.
• Antibiotic stewardship and judicious use are crucial for preventing and managing CDI.
• Fecal microbiota transplantation shows promise but requires further investigation in critically ill populations.

Conclusions:

• Management of Clostridioides difficile infection in critically ill patients presents unique challenges due to limited specific evidence.
• Further well-designed studies are essential to establish effective treatment protocols, including the role of fecal microbiota transplantation.
• Addressing antibiotic overuse and understanding ICU-specific pathophysiology are key to improving patient outcomes.