ArticleSurgical infections2013
Intracolonic vancomycin for severe Clostridium difficile colitis.
Article in Surgical infections, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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Who cites it
14 citing papers in PubMed, 41 citations in OpenAlex.
- Gastroenterological Surgery and Management ofJournal of the anus, rectum and colon · 2025Review
- Management of Clostridioides difficile infection in adults and challenges in clinical practice: review and comparison of current IDSA/SHEA, ESCMID and ASID guidelines.The Journal of antimicrobial chemotherapy · 2022Review
- [Clostridium difficile in the intensive care unit].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2020Review
- Recent advances in the treatment ofInfection and drug resistance · 2019Article
- Management ofTherapeutic advances in gastroenterology · 2019Review
- Sleeping with the enemy: Clostridium difficile infection in the intensive care unit.Critical care (London, England) · 2017Review
- [Clostridium difficile infections in geriatric patients].Zeitschrift fur Gerontologie und Geriatrie · 2016Review
- The efficacy of intracolonic vancomycin for severe Clostridium difficile colitis: a case series.BMC infectious diseases · 2016Article
- Clostridium difficile Infection.Microbiology spectrum · 2016Review
- Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA).World journal of emergency surgery : WJES · 2016Review
- Vancomycin Enemas as Adjunctive Therapy for Clostridium difficile Infection.Journal of clinical medicine research · 2015Article
- WSES guidelines for management of Clostridium difficile infection in surgical patients.World journal of emergency surgery : WJES · 2015Review
- The potential for emerging therapeutic options for Clostridium difficile infection.Gut microbes · 2014Review
- 2019 update of the WSES guidelines for management ofWorld journal of emergency surgery : WJESReview
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Authors and funding
8 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundClostridium difficile colitis is associated with increased age, antibiotic usage, and hospitalization. Severe C. difficile colitis refractory to medical therapy may require surgical intervention including subtotal colectomy. We initiated an adjuvant intracolonic vancomycin (ICV) enema protocol for inpatients with severe C. difficile colitis and compared the response to this therapy in patients from the community and nursing homes.
methodsA single-hospital, retrospective chart review was done on 47 consecutive patients with C. difficile colitis treated with ICV (1 g/500 mL normal saline q6h) from January 2007 through October 2009. The proportions of patients with the outcomes of response to the ICV protocol, need for subtotal colectomy, and death were described. Associations of patient characteristics with these outcomes were examined with bivariate tests and multivariable logistic models with adjustment for age, hypoalbuminemia, acidosis, and nursing-home status.
resultsThirty-three of 47 patients (70%) with severe C. difficile colitis responded to adjunct ICV with complete resolution without surgery. Incomplete responders who had surgery were more likely to survive than those patients who did not undergo subtotal colectomy (p<0.01). Seven of nine patients who underwent surgery survived >90 d, and overall, 37 of 47 patients (79%) survived after ICV therapy. Nursing-home residence, acidosis, and hypoalbuminemia were significantly associated with the non-resolution of colitis in bivariate analyses (all p<0.01), whereas nursing-home residence and hypoalbuminemia showed non-significant trends toward association with death (p=0.07 and p=0.06, respectively). Multivariate logistic-regression models showed significant associations of acidosis with an incomplete response to ICV (p=0.02), of older age with death (p=0.04), and of hypoalbuminemia with both an incomplete response to ICV and death (both p=0.04). No complications were attributable to ICV.
conclusionComplete resolution without surgery was achieved in 70% in this series of patients with severe C. difficile colitis who received adjunct ICV therapy. A clinical trial will be needed to determine whether ICV as compared with standard therapy alone can reduce the need for surgery with non-inferior or superior outcomes.
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