scholarly journals Colonic lavage in treatment of refractory Clostridium difficile infection: an adaptation of the Pittsburgh protocol

2020 ◽  
Vol 2020 (7) ◽  
Author(s):  
Maura Morgan ◽  
Timothy Farrell ◽  
Gordian U Ndubizu ◽  
Timothy J Farrell
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Surgical Intervention ◽  
Total Colectomy ◽  
Loop Ileostomy ◽  
Ileocecal Valve ◽  
Retrograde Flow ◽  
Fecal Stream ◽  
Colonic Lavage ◽  
And Control

Abstract Clostridium difficile infection (CDI) is a common nosocomial sequela in patients treated with antibiotics. Surgical intervention is indicated in fulminant cases. However, the mortality associated with total colectomy and end ileostomy is high. Previous reports have indicated that surgical intervention for severe complicated CDI with formation of a loop ileostomy leading to the diversion of fecal stream followed by colonic lavage can be beneficial in treating severe CDI. This procedure is known as the Pittsburgh protocol and has been reported to decrease the mortality and the need for a total colectomy in patients with severe complicated CDI. In this case, we present a 75-year-old female with refractory CDI. In her treatment, we adapted the Pittsburgh protocol and utilized a 20-French MIC gastrostomy tube to recreate the ileocecal valve and control the colonic lavage without retrograde flow.

IBD: A Growing and Vulnerable Cohort of Hospitalized Patients with Clostridium difficile Infection

2017 ◽  
Vol 83 (6) ◽  
pp. 605-609 ◽  
Author(s):  
Allan Mabardy ◽  
Justin Mccarty ◽  
Alan Hackford ◽  
Haisar Dao
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Total Colectomy ◽  
The United States ◽  
Primary Diagnosis ◽  
Hospitalized Patients ◽  
Nationwide Inpatient Sample Database ◽  
Rising Incidence ◽  
Inflammatory Bowel ◽  
National Trends

The most recent nationwide data show a rising incidence of Clostridium difficile infection in hospitalized patients with ulcerative colitis (UC). We describe recent national trends with regard to incidence, mortality, and the rate of total colectomy. The Nationwide Inpatient Sample database identified patients admitted to hospitals in the United States with diagnoses of C. difficile and inflammatory bowel disease (IBD) during the study years 2007 to 2013. We analyzed incidence of C. difficile, mortality, and colectomy rates. From 2007 to 2013, incidence of patients with IBD admitted with the primary diagnosis of C. difficile rose faster than the non-IBD population (1.24% to 2.14% vs 0.26% to 0.30%, P < 0.0001) and specifically in the UC population rose from 2.36 to 3.48 per cent (P < 0.001). The mortality of non-IBD patients with C. difficile decreased 47 per cent (3.76% to 1.99%, P = 0.003), whereas mortality of IBD patients with C. difficile decreased 54 per cent (6.08% to 2.79%, P = 0.003). For UC patients with primary diagnosis C. difficile, the percentage undergoing total colectomy decreased by 38 per cent (2.47% vs 1.51%, P = 0.049). The incidence of C. difficile continues to rise in the both the IBD and non-IBD population. Our study shows decreasing mortality for IBD and non-IBD patients with C. difficile but a greater decrease in mortality for IBD patients.

scholarly journals How is diarrhoea managed in UK care homes? A survey with implications for recognition and control of Clostridium difficile infection

2010 ◽  
Vol 32 (4) ◽  
pp. 472-478 ◽  
Author(s):  
H. J. Henderson ◽  
L. Maddock ◽  
S. Andrews ◽  
P. Trail ◽  
N. Loades ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Care Homes ◽  
And Control

scholarly journals Does Adjunctive Tigecycline Improve Outcomes in Severe-Complicated, Nonoperative Clostridium difficile Infection?

2017 ◽  
Vol 4 (1) ◽  
Author(s):  
Mary T. LaSalvia ◽  
Westyn Branch-Elliman ◽  
Graham M. Snyder ◽  
Monica V. Mahoney ◽  
Carolyn D. Alonso ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Surgical Intervention ◽  
Small Sample Size ◽  
Severity Of Illness ◽  
Small Sample ◽  
High Rate ◽  
Limited Power ◽  
Severe Clostridium Difficile Infection ◽  
To Receive

Abstract Severe Clostridium difficile infection is associated with a high rate of mortality; however, the optimal treatment for severe- complicated infection remains uncertain for patients who are not candidates for surgical intervention. Thus, we sought to evaluate the benefit of adjunctive tigecycline in this patient population using a retrospective cohort adjusted for propensity to receive tigecycline. We found that patients who received tigecycline had similar outcomes to those who did not, although the small sample size limited power to adjust for comorbidities and severity of illness.

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