Role of Surgery in Clostridium difficile Infection

Abstract

Clostridium (reclassified as “Clostridioides”) difficile infection (CDI) occurs as a chronic or an acute illness with intensity varying from mild to severe. Although most cases of CDI can be managed with antibiotics and supportive care, when the patient presents with fulminant disease, the early decision to perform surgery is imperative for survival. The current standard of care is the subtotal colectomy. However, loop ileostomy with vancomycin enemas delivered into the colonic mucosa has been described as a viable option on selected patients.

Keywords

Clostridium difficile infection - surgery for complicated Clostridium difficile infection subtotal colectomy - loop ileostomy for complicated Clostridium difficile infection

• References

• 1 Khanna S, Pardi DS. The growing incidence and severity of Clostridium difficile infection in inpatient and outpatient settings. Expert Rev Gastroenterol Hepatol 2010; 4 (04) 409-416
• 2 Lessa FC, Mu Y, Bamberg WM. , et al. Burden of Clostridium difficile infection in the United States. N Engl J Med 2015; 372 (09) 825-834
• 3 Vindigni SM, Surawicz CM. C. difficile infection: changing epidemiology and management paradigms. Clin Transl Gastroenterol 2015; 6: e99
• 4 Rodemann JF, Dubberke ER, Reske KA, Seo DH, Stone CD. Incidence of Clostridium difficile infection in inflammatory bowel disease. Clin Gastroenterol Hepatol 2007; 5 (03) 339-344
• 5 Vesteinsdottir I, Gudlaugsdottir S, Einarsdottir R, Kalaitzakis E, Sigurdardottir O, Bjornsson ES. Risk factors for Clostridium difficile toxin-positive diarrhea: a population-based prospective case-control study. Eur J Clin Microbiol Infect Dis 2012; 31 (10) 2601-2610
• 6 Voth DE, Ballard JD. Clostridium difficile toxins: mechanism of action and role in disease. Clin Microbiol Rev 2005; 18 (02) 247-263
• 7 Ferrada P, Velopulos CG, Sultan S. , et al. Timing and type of surgical treatment of Clostridium difficile-associated disease: a practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 2014; 76 (06) 1484-1493
• 8 Cohen SH, Gerding DN, Johnson S. , et al; Society for Healthcare Epidemiology of America; Infectious Diseases Society of America. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). Infect Control Hosp Epidemiol 2010; 31 (05) 431-455
• 9 McDonald LC, Gerding DN, Johnson S. , et al. Clinical Practice Guidelines for Clostridium difficile infection in adults and children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis 2018; 66 (07) 987-994
• 10 Bagdasarian N, Rao K, Malani PN. Diagnosis and treatment of Clostridium difficile in adults: a systematic review. JAMA 2015; 313 (04) 398-408
• 11 Louie TJ, Miller MA, Mullane KM. , et al; OPT-80-003 Clinical Study Group. Fidaxomicin versus vancomycin for Clostridium difficile infection. N Engl J Med 2011; 364 (05) 422-431
• 12 Guo B, Harstall C, Louie T, Veldhuyzen van Zanten S, Dieleman LA. Systematic review: faecal transplantation for the treatment of Clostridium difficile-associated disease. Aliment Pharmacol Ther 2012; 35 (08) 865-875
• 13 Hota SS, Poutanen SM. Fecal microbiota transplantation for recurrent Clostridium difficile infection. CMAJ 2018; 190 (24) E746
• 14 Duarte-Chavez R, Wojda TR, Zanders TB, Geme B, Fioravanti G, Stawicki SP. Early results of fecal microbial transplantation protocol implementation at a community-based university hospital. J Glob Infect Dis 2018; 10 (02) 47-57
• 15 Plevin R, Callcut R. Update in sepsis guidelines: what is really new? Trauma Surg Acute Care Open. 2017; 2 (01) e000088
• 16 Weisberg A, Park P, Cherry-Bukowiec JR. Early goal-directed therapy: the history and ongoing impact on management of severe sepsis and septic shock. Surg Infect (Larchmt) 2018; 19 (02) 142-146
• 17 Kulaylat AS, Kassam Z, Hollenbeak CS, Stewart Sr DB. A surgical Clostridium-associated risk of death score predicts mortality after colectomy for Clostridium difficile . Dis Colon Rectum 2017; 60 (12) 1285-1290
• 18 Lamontagne F, Labbé AC, Haeck O. , et al. Impact of emergency colectomy on survival of patients with fulminant Clostridium difficile colitis during an epidemic caused by a hypervirulent strain. Ann Surg 2007; 245 (02) 267-272
• 19 Ferrada P, Callcut R, Zielinski MD. , et al. Loop ileostomy vs. total colectomy as surgical treatment for Clostridium difficile associated disease: an eastern association for the surgery of trauma multicenter trial. J Trauma Acute Care Surg 2017
• 20 Pépin J, Valiquette L, Alary ME. , et al. Clostridium difficile-associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity. CMAJ 2004; 171 (05) 466-472
• 21 van der Wilden GM, Chang Y, Cropano C. , et al. Fulminant Clostridium difficile colitis: prospective development of a risk scoring system. J Trauma Acute Care Surg 2014; 76 (02) 424-430
• 22 Neal MD, Alverdy JC, Hall DE, Simmons RL, Zuckerbraun BS. Diverting loop ileostomy and colonic lavage: an alternative to total abdominal colectomy for the treatment of severe, complicated Clostridium difficile associated disease. Ann Surg 2011; 254 (03) 423-427 , discussion 427–429
• 23 Sailhamer EA, Carson K, Chang Y. , et al. Fulminant Clostridium difficile colitis: patterns of care and predictors of mortality. Arch Surg 2009; 144 (05) 433-439 , discussion 439–440
• 24 Rezende-Neto JB, Rotstein OD. Abdominal catastrophes in the intensive care unit setting. Crit Care Clin 2013; 29 (04) 1017-1044
• 25 Thai H, Guerron AD, Bencsath KP, Liu X, Loor M. Fulminant Clostridium difficile enteritis causing abdominal compartment syndrome. Surg Infect (Larchmt) 2014; 15 (06) 821-825
• 26 Fashandi AZ, Ellis SR, Smith PW, Hallowell PT. Overwhelming recurrent clostridium difficile infection after reversal of diverting loop ileostomy created for prior fulminant C. difficile colitis. Am Surg 2016; 82 (08) e194-e195
• 27 Fashandi AZ, Martin AN, Wang PT. , et al. An institutional comparison of total abdominal colectomy and diverting loop ileostomy and colonic lavage in the treatment of severe, complicated Clostridium difficile infections. Am J Surg 2017; 213 (03) 507-511
• 28 Stewart DB. Loop ileostomy for Clostridium difficile infection: know thy enemy. J Trauma Acute Care Surg 2017; 83 (06) 1214-1215
• 29 Eliakim-Raz N, Bishara J. Prevention and treatment of Clostridium difficile associated diarrhea by reconstitution of the microbiota. Hum Vaccin Immunother 2019; 15 (06) 1453-1456
• 30 Juul FE, Garborg K, Bretthauer M. , et al. Fecal microbiota transplantation for primary Clostridium difficile infection. N Engl J Med 2018; 378 (26) 2535-2536
• 31 Messias BA, Franchi BF, Pontes PH, Barbosa DÁAM, Viana CAS. Fecal microbiota transplantation in the treatment of Clostridium difficile infection: state of the art and literature review. Rev Col Bras Cir 2018; 45 (02) e1609