Clostridium difficile infection surgery: Difference between revisions
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=== Clinical Features and Lab Findings That Warrant Surgical Consultation and Management === | === 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: | According to the 2013 practice guidelines for diagnosis, treatment, and prevention of ''C. difficile'' infections<ref name="pmid23439232">{{cite journal| author=Surawicz CM, Brandt LJ, Binion DG, Ananthakrishnan AN, Curry SR, Gilligan PH et al.| title=Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. | journal=Am J Gastroenterol | year= 2013 | volume= 108 | issue= 4 | pages= 478-98; quiz 499 | pmid=23439232 | doi=10.1038/ajg.2013.4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23439232 }} </ref>, consider surgical consultation and management among patients with the following clinical features and lab findings: | ||
* Hypotension requiring vasopressor therapy | * Hypotension requiring vasopressor therapy | ||
* Clinical signs of sepsis | * Clinical signs of sepsis | ||
Revision as of 16:19, 24 April 2015
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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[1], 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.
References
- ↑ Surawicz CM, Brandt LJ, Binion DG, Ananthakrishnan AN, Curry SR, Gilligan PH; et al. (2013). "Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections". Am J Gastroenterol. 108 (4): 478–98, quiz 499. doi:10.1038/ajg.2013.4. PMID 23439232.