Intracolonic Administration of Vancomycin in Intensive Care Unit Patients with Severe Clostridium Difficile Colitis
| Autor: | Omar Sorour, Garrison Davis, Yesenia Greeff, Paul Mccallion, Kartikeya Tripathi, Khaled Sorour, Alex Teixeira |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
intracolonic vancomycin
medicine.medical_specialty colitis Fulminant vancomycin Infectious Disease 030204 cardiovascular system & hematology law.invention Sepsis Clostridium Difficile Colitis sepsis 03 medical and health sciences 0302 clinical medicine law colonoscopy Internal medicine medicine Internal Medicine Colitis clostridium difficile infection business.industry General Engineering Gastroenterology Clostridium difficile medicine.disease Intensive care unit Adjunctive treatment Vancomycin business 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | Cureus |
| ISSN: | 2168-8184 |
| Popis: | Background Clostridium difficile infection (CDI) is a major cause of antibiotic-associated diarrhea worldwide. The incidence of sepsis has been shown to be increasing due to severe or fulminant colitis. Oral vancomycin is the treatment of choice for CDI, but it is often ineffective in patients in the intensive care unit (ICU) due to poor intestinal motility. We present a review of eight cases with severe to fulminant CDI treated with adjunctive intracolonic vancomycin (ICV) administration. Methods A retrospective chart review identified patients in sepsis with severe colitis and positive Clostridium difficile toxin A or B. Patients who had failed standard therapy for CDI were given adjunctive ICV through an enteric tube, which was inserted via colonoscopy. To indicate the severity of patients, the patients selected had required vasopressor support. Results Eight patients (37.5% females) received this adjunctive treatment; the mean age was 73.25. The average Acute Physiology and Chronic Health Evaluation (APACHE) 2 score at the time of the procedure was 39. The median length of stay was 5.5 days, with in-hospital mortality of 37.5% and an average time to death of 1.33 days from the day of colonoscopy. Conclusion: Colonoscopic decompression and administration of vancomycin for fulminant CDI using an enteric tube can have favorable outcomes in severely ill patients whose surgical options carry a high risk of mortality. Further larger randomized controlled trials are needed to evaluate its efficacy. |
| Databáze: | OpenAIRE |
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