WSES guidelines for management of Clostridium difficile infection in surgical patients

World Journal of Emergency Surgery, Aug 2015

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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WSES guidelines for management of Clostridium difficile infection in surgical patients

Department of Surgery, Macerata Hospital, Via Santa Lucia WSES guidelines for management of Clostridium difficile infection in surgical patients 0 Department of Surgery, Macerata Hospital , Via Santa Lucia 2, 62019 Macerata , Italy 1 Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità , Rome , Italy 2 of General Surgery and Organ Transplantation, Department of Surgery, Catholic University of the Sacred Heart , Rome , Italy 3 AP-HP Bichat hospital, Medical and infectious diseases ICU , Paris , France 4 Emergency Medicine and Surgery, Macerata hospital , Macerata , Italy 5 Department of Surgery, The Pennsylvania State University, College of Medicine , Hershey, PA , USA 6 Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital , Rennes , France 7 Infection Prevention/Epidemiology, Providence Saint John's Health Center , Santa Monica, CA , USA 8 Infection Control Unit, Angers University , CHU d'Angers, Angers , France 9 Department of Surgery, Ancona University Hospital , Ancona , Italy 10 1st Surgical Clinic, University Hospital of St. Ann Brno , Brno , Czech Republic 11 Clinic of Infectious Diseases, St Orsola-Malpighi University Hospital , Bologna , Italy 12 Department of Surgery, Radboud University Medical Center , Nijmegen , Netherlands 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. - of particular interest. Surgery, especially gastrointestinal surgery, may predispose patients to the development of CDI. Surgery is also a treatment option in severe cases of CDI [8–11]. Optimization of the perioperative CDI patient management is therefore necessary for reduction in health care costs, as well as patient morbidity and mortality. To provide empirical guidelines for the surgeon called upon to assist in the care of the CDI patient, an international multidisciplinary panel of experts worldwide have prepared these evidenced-based guidelines for the management of C. difficile infection. In constituting the expert panel, the board of World Society of Emergency Surgery © 2015 Sartelli et al. 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. (WSES) involves many of the world’s leading surgical experts in management of CDI. This expert panel includes professionals who treat CDI patients on a daily basis as well as those with research interests in the condition. These guidelines outline clinical recommendations based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) hierarchy criteria summarized in Table 1 [12, 13]. Recommendations Diagnosis 1) Stool testing should only be performed on diarrhea stools from at-risk patients with clinically significant diarrhea (Recommendation 1 C). 2) For patients with ileus who may be unable to pro duce stool specimens, polymerase chain reaction testing of perirectal swabs may be an accurate and efficient method to detect toxigenic C. difficile in patients with symptoms of CDI (Recommendation 2B). 3) Nucleic acid amplification tests (NAAT) such as poly merase chain reaction (PCR) for C. difficile toxin genes appear to be sensitive and specific and may be used as a standard diagnostic test for CDI. NAAT as single-step algorithm can increase detection of asymptomatic colonization therefore it should only be performed in patients with clinical suspicion for CDI (Recommendation 1 B). 4) Glutamate dehydrogenase (GDH) screening tests for C. difficile are sensitive but do not differentiate between toxigenic and non-toxigenic strains. They may be used in association with toxin A and B EIA testing. Algorithms involving screening with an EIA for GDH followed by a toxin assay may be used (Recommendation 1 B). 5) Enzyme immunoassay (EIA) for toxin A/B is fast and inexpensive and has high specificity but it is not recommended alone due to its relatively low sensitivity. (Recommendation 1 B). 6) Clostridium difficile culture is relatively slow but sensitive. It is rarely performed today as a routine (...truncated)


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Massimo Sartelli, Mark Malangoni, Fikri Abu-Zidan, Ewen Griffiths, Stefano Di Bella, Lynne McFarland, Ian Eltringham, Vishal Shelat, George Velmahos, Ciarán Kelly, Sahil Khanna, Zaid Abdelsattar, Layan Alrahmani, Luca Ansaloni, Goran Augustin, Miklosh Bala, Frédéric Barbut, Offir Ben-Ishay, Aneel Bhangu, Walter Biffl, Stephen Brecher, Adrián Camacho-Ortiz, Miguel Caínzos, Laura Canterbury, Fausto Catena, Shirley Chan, Jill Cherry-Bukowiec, Jesse Clanton, Federico Coccolini, Maria Cocuz, Raul Coimbra, Charles Cook, Yunfeng Cui, Jacek Czepiel, Koray Das, Zaza Demetrashvili, Isidoro Di Carlo, Salomone Di Saverio, Irina Dumitru, Catherine Eckert, Christian Eckmann, Edward Eiland, Mushira Enani, Mario Faro, Paula Ferrada, Joseph Forrester, Gustavo Fraga, Jean Frossard, Rita Galeiras, Wagih Ghnnam, Carlos Gomes, Venkata Gorrepati, Mohamed Ahmed, Torsten Herzog, Felicia Humphrey, Jae Kim, Arda Isik, Rao Ivatury, Yeong Lee, Paul Juang, Luis Furuya-Kanamori, Aleksandar Karamarkovic, Peter K Kim, Yoram Kluger, Wen Ko, Francis LaBarbera, Jae Lee, Ari Leppaniemi, Varut Lohsiriwat, Sanjay Marwah, John Mazuski, Gokhan Metan, Ernest Moore, Frederick Moore, Carl Nord, Carlos Ordoñez, Gerson Júnior, Nicola Petrosillo, Francisco Portela, Basant Puri, Arnab Ray, Mansoor Raza, Miran Rems, Boris Sakakushev, Gabriele Sganga, Patrizia Spigaglia, David Stewart, Pierre Tattevin, Jean Timsit, Kathleen To, Cristian Tranà, Waldemar Uhl, Libor Urbánek, Harry van Goor, Angela Vassallo, Jean Zahar, Emanuele Caproli, Pierluigi Viale. WSES guidelines for management of Clostridium difficile infection in surgical patients, World Journal of Emergency Surgery, 2015, pp. 38, 10, DOI: 10.1186/s13017-015-0033-6