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Clostridium Difficile

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Loop ileostomy versus total colectomy as surgical treatment for Clostridium difficile-associated disease: An Eastern Association for the Surgery of Trauma multicenter trial.
Ferrada P, Callcut R, Zielinski MD, Bruns B, Yeh DD, Zakrison TL, Meizoso JP, Sarani B, Catalano RD, Kim P, Plant V, Pasley A, Dultz LA, Choudhry AJ, Haut ER; EAST Multi-Institutional Trials Committee.
J Trauma Acute Care Surg. 2017 Jul;83(1):36-40.

Rationale for inclusion: the first multicenter study comparing total abdominal colectomy (TC) with loop ileostomy (LI) in the treatment of Clostridium difficile (CDAD). In this study, LI carried less mortality than TC. In patients without contraindications, LI should be considered for the surgical treatment of CDAD.

Citations - 1 (as of January 2018)

Fecal microbiota transplantation for clostridium difficile infection: a systematic review.
Drekonja D, Reich J, Gezahegn S, Greer N, Shaukat A, MacDonald R, Rutks I, Wilt TJ.
Ann Intern Med. 2015 May 5;162(9):630-8.

Rationale for inclusion: This systematic review, which includes two randomized controlled trials, shows that fecal microbiota transplantation leads to a high rate of symptom resolution and may be more effective than vancomycin in recurrent CDI.

Citations - 115 (as of July 2017)

Oral, capsulized, frozen fecal microbiota transplantation for relapsing clostridium difficile infection.
Youngster I, Russell GH, Pindar C, Ziv-Baran T, Sauk J, Hohmann EL.
JAMA. 2014 Nov 5;312(17):1772-8.

Rationale for inclusion: this is one of the first studies showing the safety of taking poop by frozen pill, rather than nasogastric tube infusion. 

Citations - 305 (as of July 2017)

Timing and type of surgical treatment of clostridium difficile-associated disease: a practice management guideline from the Eastern Association for the Surgery of Trauma.
Ferrada P, Velopulos CG, Sultan S, Haut ER, Johnson E, Praba-Egge A, Enniss T, Dorion H, Martin ND, Bosarge P, Rushing A, Duane TM.
J Trauma Acute Care Surg. 2014 Jun;76(6):1484-93.

Rationale for inclusion: this EAST PMG provides a summary of the evidence (poor) and attempts to provide guidance regarding timing and procedure.

Citations - 17 (as of July 2017)

Fulminant clostridium difficile colitis: prospective development of a risk scoring system.
van der Wilden GM, Chang Y, Cropano C, Subramanian M, Schipper IB, Yeh DD, King DR, de Moya MA, Fagenholz PJ, Velmahos GC.
J Trauma Acute Care Surg. 2014 Feb;76(2):424-30.

Rationale for inclusion: this study provides a scoring system to help identify patients at risk of developing fulminant C.diff and will require total colectomy.

Citations - 27 (as of July 2017)

Clostridium difficile colitis in the United States: a decade of trends, outcomes, risk factors for colectomy, and mortality after colectomy.
Halabi WJ, Nguyen VQ, Carmichael JC, Pigazzi A, Stamos MJ, Mills S.
J Am Coll Surg. 2013 Nov;217(5):802-12.

Rationale for inclusion: This large study using the NIS documents the rising incidence, risk factors for mortality after colectomy, and also poorer outcomes associated with delayed colectomy.

Citations - 44 (as of July 2017)

Duodenal infusion of donor feces for recurrent clostridium difficile.
van Nood E, Vrieze A, Nieuwdorp M, Fuentes S, Zoetendal EG, de Vos WM, Visser CE, Kuijper EJ, Bartelsman JF, Tijssen JG, Speelman P, Dijkgraaf MG, Keller JJ.
N Engl J Med. 2013 Jan 31;368(5):407-15.

Rationale for inclusion: donor feces is significantly more effective than vancomycin in the treatment of recurrent C. diff infection.

Citations - 1614 (as of July 2017)

Fidoxamicin versus vancomycin for infection with clostridium difficile in Europe, Canada, and the USA: a double-blind, non-inferiority, randomised controlled trial.
Cornely OA, Crook DW, Esposito R, Poirier A, Somero MS, Weiss K, Sears P, Gorbach S; OPT-80-004 Clinical Study Group.
Lancet Infect Dis. 2012 Apr;12(4):281-9.

Rationale for Inclusion: Although only 68% of subjects were inpatient, 24% of all subjects had severe C.diff, so this study may be relevant to our practice.  Subgroup analyses favored fidaxomicin for those receiving concomitant antibiotics and in the severe C. diff subgroup.

CAVEAT: The sponsor of the study (Optimer Pharmaceuticals) was responsible for study design, data collection, and data analysis.

Citations - 405 (as of July 2017)

Diverting loop ileostomy and colonic lavage: an alternative to total abdominal colectomy for the treatment of severe, complicated clostridium difficile associated disease.
Neal MD, Alverdy JC, Hall DE, Simmons RL, Zuckerbraun BS.
Ann Surg. 2011 Sep;254(3):423-7; discussion 427-9.

Rationale for inclusion: this is the classic “Pittsburg protocol” for diverting loop ileostomy and colonic lavage.  The jury is still out on whether or not it is truly beneficial….  It is only one single center, retrospective study.

Citations - 206 (as of July 2017)

Proton pump inhibitors and risk for recurrent clostridium difficile infection.
Linsky A, Gupta K, Lawler EV, Fonda JR, Hermos JA.
Arch Intern Med. 2010 May 10;170(9):772-8.

Rationale for inclusion: additional correlational evidence of the connection between gastric acid suppression and C. diff recurrence.

Citations - 259 (as of July 2017)

Clinical practice guidelines for clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA).
Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC, Pepin J, Wilcox MH; Society for Healthcare Epidemiology of America; Infectious Diseases Society of America.
Infect Control Hosp Epidemiol. 2010 May;31(5):431-55.

Rationale for inclusion: this is an excellent practice recommendation published by the Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America.

Citations - 2386 (as of July 2017)

Fulminant clostridium difficile colitis: patterns of care and predictors of mortality.
Sailhamer EA, Carson K, Chang Y, Zacharias N, Spaniolas K, Tabbara M, Alam HB, DeMoya MA, Velmahos GC.
Arch Surg. 2009 May;144(5):433-9; discussion 439-40.

Rationale for inclusion: for patients with fulminant C. diff, early operation was associated with lower mortality and those admitted to surgical services had lower mortality, possibly due to shorter delay to colectomy.

Citations - 181 (as of July 2017)

A comparison of vancomycin and metronidazole for the treatment of clostridium difficile-associated diarrhea, stratified by disease severity.
Zar FA, Bakkanagari SR, Moorthi KM, Davis MB.
Clin Infect Dis. 2007 Aug 1;45(3):302-7. Epub 2007 Jun 19.

Rationale for inclusion: this study supports the use of vancomycin over metronidazole for severe C.diff.

Citations - 987 (as of July 2017)

Impact of emergency colectomy on survival of patients with fulminant clostridium difficile colitis during an epidemic caused by a hypervirulent strain.
Lamontagne F, Labbé AC, Haeck O, Lesur O, Lalancette M, Patino C, Leblanc M, Laverdière M, Pépin J.
Ann Surg. 2007 Feb;245(2):267-72.

Rationale for inclusion: emergency colectomy is beneficial in fulminant C. diff.

Citations - 314 (as of July 2017)

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