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Clostridium difficile in the ICU: the struggle continues.

Authors
  • Bobo, Linda D1
  • Dubberke, Erik R2
  • Kollef, Marin3
  • 1 Adult Infectious Diseases Division, Washington University School of Medicine, St. Louis, MO. Electronic address: [email protected]
  • 2 Adult Infectious Diseases Division, Washington University School of Medicine, St. Louis, MO.
  • 3 Pulmonary and Critical Care Division, Washington University School of Medicine, St. Louis, MO.
Type
Published Article
Journal
CHEST Journal
Publisher
Elsevier
Publication Date
December 2011
Volume
140
Issue
6
Pages
1643–1653
Identifiers
DOI: 10.1378/chest.11-0556
PMID: 22147824
Source
Medline
License
Unknown

Abstract

Clostridium difficile infection (CDI) management has become more daunting over the past decade because of alarming increases in CDI incidence and severity both in the hospital and in the community. This increase has concomitantly caused significant escalation of the health-care economic burden caused by CDI, and it will likely be translated to increased ICU admission and attributable mortality. Some possible causes for difficulty in management of CDI are as follows: (1) inability to predict and prevent development of severe/complicated or relapsing CDI in patients who initially present with mild symptoms; (2) lack of a method to determine who would have benefited a priori from initiating vancomycin treatment first instead of treatment with metronidazole; (3) lack of sensitive and specific CDI diagnostics; (4) changing epidemiology of CDI, including the emergence of a hypervirulent, epidemic C difficile strain associated with increased morbidity and mortality; (5) association of certain high-usage nonantimicrobial medications with CDI; and (6) lack of treatment regimens that leave the normal intestinal flora undisturbed while treating the primary infection. The objective of this article is to present current management and prevention guidelines for CDI based on recommendations by the Society for Healthcare Epidemiology of America and Infectious Diseases Society of America and potential new clinical management strategies on the horizon.

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