0
Postgraduate Education Corner |

Clostridium difficile in the ICUClostridium difficile in the ICU: The Struggle Continues

Linda D. Bobo, MD, PhD; Erik R. Dubberke, MD, MSPH; Marin Kollef, MD, FCCP
Author and Funding Information

From the Adult Infectious Diseases Division (Drs Bobo and Dubberke) and Pulmonary and Critical Care Division (Dr Kollef), Washington University School of Medicine, St. Louis, MO.

Correspondence to: Linda D. Bobo, MD, PhD, Southern Illinois Medical Services, Infectious Diseases, Center for Medical Arts, 2601 W Main St, Carbondale, IL 62901; e-mail: linda.bobo@sih.net

CDI = Clostridium difficile infection.

During calculation for surgery, appropriate antimicrobial treatment (see Table 3) and hemodynamic resuscitation should occur. See Table 1 legend for expansion of abbreviation.

a

Complications include toxic megacolon, ileus, bowel perforation, systemic inflammatory response syndrome, or sepsis.

EIA = enzyme immunoassay; GDH = glutamate dehydrogenase; PCR = polymerase chain reaction.

a

GDH followed by a more sensitive test, such as PCR or cytotoxicity.

b

EIA must include A and B.

c

L. Bobo, MD, PhD, unpublished data.

d

Tissue culture of stool.

e

Anaerobic culture of stool followed by tissue culture on isolate.

Funding/Support: This study was supported by National Institutes of Health [Grants T32-AI007172 in molecular microbiology and UL1 RR024992 in clinical and translational research (L. D. B.) and Grant K23AI065806 (E. R. D.)] and Barnes-Jewish Hospital Foundation (M. K.).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


Funding/Support: This study was supported by National Institutes of Health [Grants T32-AI007172 in molecular microbiology and UL1 RR024992 in clinical and translational research (L. D. B.) and Grant K23AI065806 (E. R. D.)] and Barnes-Jewish Hospital Foundation (M. K.).

Funding/Support: This study was supported by National Institutes of Health [Grants T32-AI007172 in molecular microbiology and UL1 RR024992 in clinical and translational research (L. D. B.) and Grant K23AI065806 (E. R. D.)] and Barnes-Jewish Hospital Foundation (M. K.).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


Chest. 2011;140(6):1643-1653. doi:10.1378/chest.11-0556
Text Size: A A A
Published online

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.


Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
Guidelines
Feverish illness in children: assessment and initial management in children younger than 5 years.
National Collaborating Centre for Women's and Children's Health | 8/28/2009
Blepharitis.
American Academy of Ophthalmology | 6/5/2009
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543