Treatment of Severe and Fulminant Clostridioides difficile Infections

Severe and fulminant Clostridioides difficile infection (CDI) represent distinct clinical entities that portend poor outcomes and require close monitoring and multidisciplinary management. Early recognition is key, and CDI-directed antimicrobials are the mainstay of therapy. If patients fail to improve despite maximal medical therapy, fecal microbiota transplantation (FMT) or surgical intervention should be considered. If FMT is performed, repeated dosing is often required. Surgical interventions such as colectomy or loop ileostomy are necessary in FMT nonresponders or those who have developed a complication such as perforation.