COMMENTARY

5 Important Developments in C difficile Management

John G. Bartlett, MD

Disclosures

August 26, 2013

In This Article

Surgical Treatment for CDI

A new surgical procedure for CDI has been developed: diverting loop ileostomy with colonic vancomycin lavage. The surgical experience with CDI has previously consisted of colectomy in patients who are critically ill, often with toxic megacolon. Mortality rates are high, and surviving patients suffer the consequences of living without a colon.

Surgeons at the University of Pittsburgh had extensive experience in the midst of a CDI epidemic and have subsequently reported a new surgical approach, consisting of a diverting ileostomy in place of colectomy. A retrospective comparison of 42 patients who underwent the new procedure with 42 who had previously had colectomy for refractory CDI showed mortality rates of 19% vs 50% favoring the new procedure.[9]

Clinical relevance. It is hoped that diverting loop ileostomy procedure will replace colectomy as the standard surgical procedure for most patients with severe CDI who require surgery.

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