The efficacy of intracolonic vancomycin for severe Clostridium difficile colitis: a case series
| Autor: | Michael B. Ing, Christine M. Akamine, Lawrence K. Loo, Christian S. Jackson |
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| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty Toxic megacolon genetic structures Colon medicine.medical_treatment law.invention Clostridium Difficile Colitis Intracolonic Megacolon Toxic 03 medical and health sciences 0302 clinical medicine law Vancomycin Internal medicine Metronidazole medicine Humans 030212 general & internal medicine Mortality Enterocolitis Pseudomembranous Colectomy Aged Retrospective Studies business.industry Clostridioides difficile Standard treatment Drug Administration Routes Clostridium difficile Middle Aged medicine.disease Colitis Intensive care unit Surgery Anti-Bacterial Agents Intensive Care Units Infectious Diseases Risk factors 030211 gastroenterology & hepatology Female business medicine.drug Research Article Intracolonic vancomycin |
| Zdroj: | BMC Infectious Diseases |
| ISSN: | 1471-2334 |
| Popis: | Background Clostridium difficile infection (CDI) unresponsive to the standard treatments of metronidazole and oral vancomycin requires aggressive medical management and possible surgical intervention including colectomy. Intracolonic vancomycin therapy has been reported to be particularly promising in the setting of severe CDI in the presence of ileus. This is a descriptive case series exploring the effect of adjunctive intracolonic vancomycin therapy on the morbidity and mortality in patients with moderate to severe CDI. Methods A retrospective chart review was conducted on 696 patients with CDI seen at a single institution. Each patient was assigned a severity score and 127 patients with moderate to severe CDI were identified. We describe the clinical presentation, risk factors and hospital course comparing those that received adjunctive intracolonic vancomycin to those that only received standard therapy. Results The group that received adjunctive intracolonic vancomycin had higher rates of toxic megacolon, intensive care unit (ICU) admission, and colectomy, and yet maintained a similar mortality rate as the group that received only standard treatment. Conclusion The intracolonic vancomycin group experienced more complications but showed a similar mortality rate to the standard therapy group, suggesting that intracolonic vancomycin may impart a protective effect. This study adds further evidence for the need of a randomized controlled study using intracolonic vancomycin as adjunctive therapy in patients presenting with severe CDI. |
| Databáze: | OpenAIRE |
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