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Clostridium Difficile

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No survival advantage exists for patients undergoing loop ileostomy for clostridium difficile colitis.
Hall BR, Leinicke JA, Armijo PR, Smith LM, Langenfeld SJ, Oleynikov D.
Am J Surg. 2019 Jan;217(1):34-39.

Rationale for inclusion: Found no survival benefit for patients who undergo loop ileostomy for C difficile infection compared to those who undergo total colectomy; however, patients who undergo loop ileostomy are likely to retain their colon with low risk of requiring subsequent colectomy.

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Durability and Long-term Clinical Outcomes of Fecal Microbiota Transplant Treatment in Patients With Recurrent Clostridium difficile Infection.
Mamo Y1, Woodworth MH2, Wang T1, Dhere T3, Kraft CS2,4.
Clin Infect Dis. 2018 May 17;66(11):1705-1711.

Rationale for inclusion: This study addresses durability of long term outcome after fecal transplant.

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Early Fecal Microbiota Transplantation Improves Survival in Severe Clostridium difficile Infections.
Hocquart M, Lagier JC, Cassir N, Saidani N, Eldin C, Kerbaj J, Delord M, Valles C, Brouqui P, Raoult D, Million M.
Clin Infect Dis. 2018 Feb 10;66(5):645-650.

Rationale for inclusion: One of the few articles that demonstrate effect of Early fecal transplantation on mortality for severe C diff.

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Effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infection: a systematic review and meta-analysis
Baur D, Gladstone BP, Burkert F, Carrara E, Foschi F, Döbele S, Tacconelli E
Lancet Infect Dis. 2017 Sep;17(9):990-1001

Rationale for inclusion: Important for the all aspects of acute care surgeons and intensvists. Demonstrates the benefits of antibiotic stewardship programs.

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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.

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Faecal microbiota transplantation plus selected use of vancomycin for severe-complicated Clostridium difficile infection: description of a protocol with high success rate
Fischer M, Sipe BW, Rogers NA, Cook GK, Robb BW, Vuppalanchi R, Rex DK
Aliment Pharmacol Ther. 2015 Aug;42(4):470-6

Rationale for inclusion: The largest series of patients undergoing fecal transplant for fulminant C. diff.

CAVEAT: Will outdate quickly

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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.

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Intestinal Microbiota Transplantation, a Simple and Effective Treatment for Severe and Refractory Clostridium Difficile Infection
Zainah H, Hassan M, Shiekh-Sroujieh L, Hassan S, Alangaden G, Ramesh M
Dig Dis Sci. 2015 Jan;60(1):181-5.

Rationale for inclusion: One of the largest series of patients undergoing fecal transplant for fulminant C. diff.

CAVEAT: Will outdate quickly

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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Effect of Inclusion of Oral Antibiotics with Mechanical Bowel Preparation on the Risk of Clostridium Difficile Infection After Colectomy
Al-Mazrou, Ahmed M.; Hyde, Laura Z.; Suradkar, Kunal; Kiran, Ravi P.
J Gastrointest Surg. 2018 Nov;22(11):1968-1975.

Rationale for inclusion: Use of oral antibiotics with mechanical bowel prep before colectomy did not increase risk of postoperative C diff, and possibly decrease the risk.

Citations  - To review the number of citations for this landmark paper, visit Google Scholar.

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