Clostridium difficile infection surgery: Difference between revisions

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Revision as of 16:17, 24 April 2015

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Indications for sugery include peritoneal signs, persistent bacteremia, progressive clinical disease with organ damage (e.g. renal or pulmonary disease), or evidence on CT scan demonstrating worsening infection.

Surgery

Indications for Surgery

Indications for surgery include:

Peritoneal signs
Persistent bacteremia
Progressive disease
Abdominal CT scan demonstrating pericolonic inflammation with increasing bowel wall edema

Clinical Features and Lab Findings That Warrant Surgical Consultation and Management

Consider surgical consultation and management among patients with the following clinical features and lab findings:

Hypotension requiring vasopressor therapy
Clinical signs of sepsis
Target organ dysfunction (e.g. renal or pulmonary disease)
Mental status changes
Leukocytosis > 50,000 cells/microL
Lactate > 5 mmol/L
Failure to improve following 5 days of antimicrobial therapy

Colectomy

Among patients who develop systemic symptoms of C. difficile colitis, colectomy may improve outcomes if performed early prior to the need for vasopressor therapy.

Subtotal colectomy with ileostomy is typically performed.

References

Template:WikiDoc Sources

@@ Line 4: / Line 4: @@
 == Overview ==
-Patients with signs/symptoms of fulminant colitits should be evaluated by surgery for possible urgent surgery for [[bowel perforation]], impending perforation, severe ileus with megacolon, or refractory [[septicemia]].
+Indications for sugery include peritoneal signs, persistent bacteremia, progressive clinical disease with organ damage (e.g. renal or pulmonary disease), or evidence on CT scan demonstrating worsening infection.
 ==Surgery==
@@ Line 12: / Line 12: @@
 * Persistent [[bacteremia]]
 * Progressive disease
-* CT showing pericolonic inflammation with increasing bowel wall edema.
+* Abdominal CT scan demonstrating pericolonic inflammation with increasing bowel wall edema
+=== Clinical Features and Lab Findings That Warrant Surgical Consultation and Management ===
+Consider surgical consultation and management among patients with the following clinical features and lab findings:
+* Hypotension requiring vasopressor therapy
+* Clinical signs of sepsis
+* Target organ dysfunction (e.g. renal or pulmonary disease)
+* Mental status changes
+* Leukocytosis > 50,000 cells/microL
+* Lactate > 5 mmol/L
+* Failure to improve following 5 days of antimicrobial therapy
 ===Colectomy===
-In those patients that develop systemic symptoms of CDC, colectomy may improve the outcome if performed before the need for [[vasopressor]]s. The usual intervention is a subtotal colectomy with [[ileostomy]].
+* Among patients who develop systemic symptoms of ''C. difficile ''colitis, colectomy may improve outcomes if performed early prior to the need for [[vasopressor]] therapy.
-=== Recurrence ===
+* Subtotal colectomy with [[ileostomy]] is typically performed.
-The evolution of protocols for patients with recurrent ''C. difficile'' diarrhea also present a challenge: there is no known proper length of time or universally accepted alternative drugs with which one should be treated. However, re-treatment with [[metronidazole]] or [[vancomycin]] at the previous dose for 10 to 14 days is generally successful. The addition of [[rifampin]] to vancomycin also has been effective. Prophylaxis with competing, nonpathogenic organisms such as ''[[Lactobacillus]]'' spp. or ''[[Saccharomyces boulardii]]'' has been found to be helpful in preventing relapse in small numbers of patients (see, for example, [[Florastor]], or [[Lactinex]]). It is thought that these organisms, also known as [[probiotics]], help to restore the natural flora in the gut and make patients more resistant to colonization by ''C. difficile''.
 ==References==