Clinical Review of the Management of FulminantClostridium difficileInfection
| Autor: | Mark E. Reeves, Wesley L. Fung, M. Raffat Jaber, Snorri Olafsson |
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| Rok vydání: | 2008 |
| Předmět: |
Abdomen
Acute Diarrhea Pediatrics medicine.medical_specialty Hepatology Clostridioides difficile business.industry medicine.medical_treatment Mortality rate Fulminant Gastroenterology Retrospective cohort study Clostridium difficile Cochrane Library Surgery Clostridium Difficile Colitis Systematic review Risk Factors medicine Humans business Algorithms Colectomy Enterocolitis Pseudomembranous |
| Zdroj: | The American Journal of Gastroenterology. 103:3195-3203 |
| ISSN: | 1572-0241 0002-9270 |
| Popis: | BACKGROUND: Clostridium difficile infection (CDI) is a frequent cause of morbidity and mortality among elderly hospitalized patients. A small but increasing number of patients have developed fulminant CDI, and a significant number of these patients require emergency colectomy. In this review, we discuss the risk factors, pathophysiology, diagnosis, and management of fulminant CDI. DATA SOURCES: A literature search (Medline, Embase, Cochrane Library, Biosis, Science Citation Index, Ovid Journals) was performed from the period between January 1980 and June 2008 using the key words "Clostridium difficile," "pseudomembranous enterocolitis," "colectomy," "acute abdomen," "antibiotic-associated diarrhea," or "fulminant Clostridium difficile colitis." Articles not in English or not related to human subjects were excluded. For this review, we analyzed the articles identified in our original search and those articles cited in the original review articles. No randomized trials were found on the surgical management of fulminant CDI and only retrospective studies with a minimum of five patients were used in the review. With respect to medical treatment, we based our review on guideline articles, systematic reviews, and available randomized trials. CONCLUSION: Both the incidence and severity of CDI are increasing. Fulminant CDI is underappreciated as a life-threatening disease because of a lack of awareness of its severity and its nonspecific clinical syndrome. Early diagnosis and treatment are essential for a good outcome, and early surgical intervention should be used in patients who are unresponsive to medical therapy. The surgical procedure of choice is a total abdominal colectomy with end ileostomy, although the mortality rate remains high. |
| Databáze: | OpenAIRE |
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