WSES guidelines for management of Clostridium difficile infection in surgical patients

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Abstract

In the last two decades there have been dramatic changes in the epidemiology of Clostridium difficile infection (CDI), with increases in incidence and severity of disease in many countries worldwide. The incidence of CDI has also increased in surgical patients. Optimization of management of C difficile, has therefore become increasingly urgent. An international multidisciplinary panel of experts prepared evidenced-based World Society of Emergency Surgery (WSES) guidelines for management of CDI in surgical patients.

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Most cited references 191

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Systematic review of intestinal microbiota transplantation (fecal bacteriotherapy) for recurrent Clostridium difficile infection.

Ethan Gough, Henna Shaikh, Amee R. Manges (2011)

Clostridium difficile infection (CDI) is a gastrointestinal disease believed to be causally related to perturbations to the intestinal microbiota. When standard treatment has failed, intestinal microbiota transplantation (IMT) is an alternative therapy for patients with CDI. IMT involves infusing intestinal microorganisms (in a suspension of healthy donor stool) into the intestine of a sick patient to restore the microbiota. However, protocols and reported efficacy for IMT vary. We conducted a systematic literature review of IMT treatment for recurrent CDI and pseudomembranous colitis. In 317 patients treated across 27 case series and reports, IMT was highly effective, showing disease resolution in 92% of cases. Effectiveness varied by route of instillation, relationship to stool donor, volume of IMT given, and treatment before infusion. Death and adverse events were uncommon. These findings can guide physicians interested in implementing the procedure until better designed studies are conducted to confirm best practices.

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Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe.

Michel Warny, Jacques Pépin, Aiqi Fang … (2005)

Toxins A and B are the primary virulence factors of Clostridium difficile. Since 2002, an epidemic of C difficile-associated disease with increased morbidity and mortality has been present in Quebec province, Canada. We characterised the dominant strain of this epidemic to determine whether it produces higher amounts of toxins A and B than those produced by non-epidemic strains. We obtained isolates from 124 patients from Centre Hospitalier Universitaire de Sherbrooke in Quebec. Additional isolates from the USA, Canada, and the UK were included to increase the genetic diversity of the toxinotypes tested. Isolate characterisation included toxinotyping, pulsed-field gel electrophoresis (PFGE), PCR ribotyping, detection of a binary toxin gene, and detection of deletions in a putative negative regulator for toxins A and B (tcdC). By use of an enzyme-linked immunoassay, we measured the in-vitro production of toxins A and B by epidemic strain and non-dominant strain isolates. The epidemic strain was characterised as toxinotype III, North American PFGE type 1, and PCR-ribotype 027 (NAP1/027). This strain carried the binary toxin gene cdtB and an 18-bp deletion in tcdC. We isolated this strain from 72 patients with C difficile-associated disease (58 [67%] of 86 with health-care-associated disease; 14 [37%] of 38 with community-acquired disease). Peak median (IQR) toxin A and toxin B concentrations produced in vitro by NAP1/027 were 16 and 23 times higher, respectively, than those measured in isolates representing 12 different PFGE types, known as toxinotype 0 (toxin A, median 848 microg/L [IQR 504-1022] vs 54 microg/L [23-203]; toxin B, 180 microg/L [137-210] vs 8 microg/L [5-25]; p<0.0001 for both toxins). The severity of C difficile-associated disease caused by NAP1/027 could result from hyperproduction of toxins A and B. Dissemination of this strain in North America and Europe could lead to important changes in the epidemiology of C difficile-associated disease.

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Oral, capsulized, frozen fecal microbiota transplantation for relapsing Clostridium difficile infection.

Ilan Youngster, George Russell, Christina Pindar … (2014)

Fecal microbiota transplantation (FMT) has been shown to be effective in treating relapsing or refractory Clostridium difficile infection, but practical barriers and safety concerns have prevented its widespread use.

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Author and article information

Contributors

Massimo Sartelli: m.sartelli@virgilio.it , massimosartelli@gmail.com

Journal

Journal ID (nlm-ta): World J Emerg Surg

Journal ID (iso-abbrev): World J Emerg Surg

Title: World Journal of Emergency Surgery : WJES

Publisher: BioMed Central (London )

ISSN (Electronic): 1749-7922

Publication date (Electronic): 20 August 2015

Publication date PMC-release: 20 August 2015

Publication date Collection: 2015

Volume: 10

Electronic Location Identifier: 38

Affiliations

[ ]Department of Surgery, Macerata Hospital, Via Santa Lucia 2, 62019 Macerata, Italy

[ ]American Board of Surgery, Philadelphia, USA

[ ]Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates

[ ]Department of Surgery, Queen Elizabeth Hospital, Birmingham, UK

[ ]2nd Infectious Diseases Division, National Institute for Infectious Diseases L. Spallanzani, Rome, Italy

[ ]Department of Medicinal Chemistry, School of Pharmacy, University of Washington, Washington, USA

[ ]Department of Medical Microbiology, King’s College Hospital, London, UK

[ ]Department of Surgery, Tan Tock Seng Hospital, Singapore, Singapore

[ ]Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA

[ ]Gastroenterology Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA USA

[ ]Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN USA

[ ]Department of Surgery, University of Michigan, Ann Arbor, MI USA

[ ]Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI USA

[ ]General Surgery I, Papa Giovanni XXIII Hospital, Bergamo, Italy

[ ]Department of Surgery, University Hospital Center Zagreb and School of Medicine, University of Zagreb, Zagreb, Croatia

[ ]Trauma and Acute Care Surgery Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel

[ ]UHLIN (Unité d’Hygiène et de Lutte contre les Infections Nosocomiales) National Reference Laboratory for Clostridium difficile Groupe Hospitalier de l’Est Parisien (HUEP), Paris, France

[ ]Department of General Surgery, Rambam Health Care Campus, Haifa, Israel

[ ]Academic Department of Surgery, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK

[ ]Department of Surgery, University of Colorado, Denver Health Medical Center, Denver, USA

[ ]Pathology and Laboratory Medicine, VA Boston Healthcare System, West Roxbury MA and BU School of Medicine, Boston, MA USA

[ ]Department of Internal Medicine, University Hospital, Dr.José E. González, Monterrey, Mexico

[ ]Department of Surgery, University of Santiago de Compostela, Santiago de Compostela, Spain

[ ]Department of Pathology, University of Alberta Edmonton, Edmonton, AB Canada

[ ]Emergency Surgery Department, Maggiore Parma Hospital, Parma, Italy

[ ]Department of General Surgery, Medway Maritime Hospital, Gillingham Kent, UK

[ ]Department of Surgery, Division of Acute Care Surgery, University of Michigan, Ann Arbor, MI USA

[ ]Department of Surgery, Northeast Ohio Medical University, Summa Akron City Hospital, Akron, OH USA

[ ]Faculty of Medicine, Transilvania University, Infectious Diseases Hospital, Brasov, Romania

[ ]Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, University of California San Diego Health Science, San Diego, USA

[ ]Division of Acute Care Surgery, Trauma and Surgical Critical Care, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA USA

[ ]Department of Surgery,Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China

[ ]Department of Infectious Diseases, Jagiellonian University, Medical College, Kraków, Poland

[ ]Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey

[ ]Department of Surgery, Tbilisi State Medical University, Kipshidze Central University Hospital, Tbilisi, Georgia

[ ]Department of Surgery, Hamad General Hospital, Doha, Qatar

[ ]Trauma Surgery Unit, Maggiore Hospital, Bologna, Italy

[ ]Clinical Infectious Diseases Hospital, Ovidius University, Constanta, Romania

[ ]National Reference Laboratory for Clostridium difficile, AP-HP, Saint-Antoine Hospital, Paris, France

[ ]Department of General, Visceral and Thoracic Surgery, Klinikum Peine, Hospital of Medical University Hannover, Peine, Germany

[ ]Vital Care, Inc, Meridian, MS USA

[ ]Department of Medicine, Section of Infectious Diseases, King Fahad Medical City, Riyadh, Saudi Arabia

[ ]Department of General Surgery, Trauma and Emergency Surgery Division, ABC Medical School, Santo André, SP Brazil

[ ]Division of Trauma, Critical Care and Emergency Surgery, Virginia Commonwealth University, Richmond, VA USA

[ ]Department of Surgery, Stanford University, Stanford, CA USA

[ ]Division of Trauma Surgery, Hospital de Clinicas, School of Medical Sciences, University of Campinas, Campinas, Brazil

[ ]Service of Gastroenterology and Hepatology, Geneva University Hospital, Genève, Switzerland

[ ]Critical Care Unit, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), A Coruña, Spain

[ ]Department of Surgery Mansoura, Faculty of Medicine, Mansoura University, Mansoura, Egypt

[ ]Surgery Department, Hospital Universitario (HU) Terezinha de Jesus da Faculdade de Ciencias Medicas e da Saude de Juiz de Fora (SUPREMA), Hospital Universitario (HU) Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, Brazil

[ ]Department of Internal Medicine, Pinnacle Health Hospital, Harrisburg, PA USA

[ ]Department of Medicine, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, Buckinghamshire UK

[ ]Department of Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany

[ ]Department of Gastroenterology and Hepatology, Ochsner Clinic Foundation, New Orleans, LA USA

[ ]Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea

[ ]General Surgery Department, Erzincan University Mengücek Gazi Training and Research Hospital, Erzincan, Turkey

[ ]School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan Malaysia

[ ]Department of Pharmacy Practice, St Louis College of Pharmacy, St Louis, MO USA

[ ]Research School of Population Health, The Australian National University, Acton, ACT Australia

[ ]Clinic For Emergency surgery, University Clinical Center of Serbia, Faculty of Medicine University of Belgrade, Belgrade, Serbia

[ ]General and Trauma Surgery, Albert Einstein College of Medicine, North Bronx Healthcare Network, Bronx, NY USA

[ ]Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan

[ ]Division of Critical Care & Trauma Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea

[ ]Abdominal Center, Helsinki University Hospital Meilahti, Helsinki, Finland

[ ]Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

[ ]Department of Surgery, Post-Graduate Institute of Medical Sciences, Rohtak, India

[ ]Department of Surgery, Washington University School of Medicine, Saint Louis, USA

[ ]Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey

[ ]Department of Surgery, University of Florida, Gainesville, FL USA

[ ]Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden

[ ]Department of Surgery, Fundación Valle del Lili, Hospital Universitario del Valle, Universidad del Valle, Cali, Colombia

[ ]Emergency Surgery and Trauma Unit, Department of Surgery, Ribeirão Preto, Brazil

[ ]Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

[ ]Department of Medicine, Hammersmith Hospital and Imperial College London, London, UK

[ ]Infectious Diseases and Microbiology Unit, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, Buckinghamshire UK

[ ]Department of Abdominal and General Surgery, General Hospital Jesenice, Jesenice, Slovenia

[ ]Department of Surgery, Medical University of Plovdiv, Plovdiv, Bulgaria

[ ]Division of General Surgery and Organ Transplantation, Department of Surgery, Catholic University of the Sacred Heart, Rome, Italy

[ ]Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy

[ ]Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA USA

[ ]Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France

[ ]AP-HP Bichat hospital, Medical and infectious diseases ICU, Paris, France

[ ]Emergency Medicine and Surgery, Macerata hospital, Macerata, Italy

[ ]1st Surgical Clinic, University Hospital of St. Ann Brno, Brno, Czech Republic

[ ]Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands

[ ]Infection Prevention/Epidemiology, Providence Saint John’s Health Center, Santa Monica, CA USA

[ ]Infection Control Unit, Angers University, CHU d’Angers, Angers, France

[ ]Department of Surgery, Ancona University Hospital, Ancona, Italy

[ ]Clinic of Infectious Diseases, St Orsola-Malpighi University Hospital, Bologna, Italy

Article

Publisher ID: 33

DOI: 10.1186/s13017-015-0033-6

PMC ID: 4545872

PubMed ID: 26300956

SO-VID: fd4e2747-d2d7-4a7f-9195-e9f557f92ac9

License:

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 22 May 2015

Date accepted : 12 August 2015

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ScienceOpen disciplines: Surgery

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ScienceOpen disciplines: Surgery

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WSES guidelines for management of Clostridium difficile infection in surgical patients

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Abstract

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25th European Students' Conference

Most cited references 191

Systematic review of intestinal microbiota transplantation (fecal bacteriotherapy) for recurrent Clostridium difficile infection.

Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe.

Oral, capsulized, frozen fecal microbiota transplantation for relapsing Clostridium difficile infection.

Author and article information

Contributors

Journal

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Article

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Cited by 30

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