Clostridium difficile infection surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Yazan Daaboul, M.D.

Overview

Indications for surgery include peritoneal signs, persistent bacteremia, progressive clinical disease with organ damage (e.g. renal or pulmonary disease), or evidence on CT scan demonstrating worsening infection.

Surgery

Indications for Surgery

Indications for surgery include:

• Peritoneal signs
• Persistent bacteremia
• Progressive disease
• Abdominal CT scan demonstrating pericolonic inflammation with increasing bowel wall edema

Clinical Features and Lab Findings That Warrant Surgical Consultation and Management

According to the 2013 practice guidelines for diagnosis, treatment, and prevention of C. difficile infections, consider surgical consultation and management among patients with the following clinical features and lab findings:

• Hypotension requiring vasopressor therapy
• Clinical signs of sepsis
• Target organ dysfunction (e.g. renal or pulmonary disease)
• Mental status changes
• Leukocytosis > 50,000 cells/microL
• Lactate > 5 mmol/L
• Failure to improve following 5 days of antimicrobial therapy

Colectomy

• Among patients who develop systemic symptoms of C. difficile colitis, colectomy may improve outcomes if performed early prior to the need for vasopressor therapy.

• Subtotal colectomy with ileostomy is typically performed.