ICU SAQs · GI and nutrition / infection
Fulminant C. difficile — diagnosis and management
A CICM SAQ on C. difficile — severity classification, multistep diagnosis, dose-level treatment regimens, surgical options and infection control.
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Prompt
A 70-year-old on broad-spectrum antibiotics develops profuse diarrhoea, a white count of 28,000/uL, a creatinine twice baseline, and abdominal distension. The toxin immunoassay is positive. Discuss the diagnosis and management.
Question
A 70-year-old on broad-spectrum antibiotics develops profuse diarrhoea, a white cell count of 28,000/uL, a creatinine twice baseline, and abdominal distension. The toxin immunoassay is positive. Discuss the diagnosis and management.[3][4][5]
References5ShowHide
- [1]Forrester JD, Colling KP, Diaz JJ, et al. Surgical Infection Society Guidelines for Total Abdominal Colectomy versus Diverting Loop Ileostomy with Antegrade Intra-Colonic Lavage for the Surgical Management of Severe or Fulminant, Non-Perforated Clostridioides difficile Colitis Surg Infect (Larchmt), 2022.PMID 34619068
- [2]Fischer M, Vaughn BP, Peery AF, Kelly CR. AGA Clinical Practice Update on Management of Clostridioides difficile Infection in Adults: Expert Review Clin Gastroenterol Hepatol, 2026.PMID 42383946
- [3]Crobach MJ, Planche T, Eckert C, et al. European Society of Clinical Microbiology and Infectious Diseases: update of the diagnostic guidance document for Clostridium difficile infection. Clin Microbiol Infect, 2016.PMID 27460910
- [4]Gateau C, Couturier J, Coia J, et al. How to: diagnose infection caused by Clostridium difficile. Clin Microbiol Infect, 2018.PMID 29269092
- [5]Oughton MT, Loo VG, Dendukuri N, et al. Hand hygiene with soap and water is superior to alcohol rub and antiseptic wipes for removal of Clostridium difficile Infect Control Hosp Epidemiol, 2009.PMID 19715426