title: Clostridium difficile infection in the intensive care unit.
abstract: Clostridium difficile infection (CDI) is an increasing nosocomial problem in North America and Western Europe, where outbreaks caused by a more virulent, toxin-hyperproducing strain have been recently reported. Clostridium difficile infection is now characterized by a higher incidence, more frequent relapses, and a higher case-fatality ratio. As a consequence, fulminant cases requiring admission to the intensive care unit (ICU) are much more common than previously. In recent years, metronidazole has appeared to lose some of its effectiveness in CDI management and vancomycin is now recognized as the first-line treatment of severe cases. Rapid diagnosis and institution of infection control measures are critical components of CDI management. The current review focuses on recent changes in the epidemiology, diagnostic methods, and treatment of CDI, with special emphasis on complicated cases managed in the ICU.
authors.affiliation: Intensive Care Unit, Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada.
authors.forename: Marc-André
authors.initials: MA
authors.lastname: Leclair
authors.forename: Catherine
authors.initials: C
authors.lastname: Allard
authors.forename: Olivier
authors.initials: O
authors.lastname: Lesur
authors.forename: Jacques
authors.initials: J
authors.lastname: Pépin
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016360:Clostridioides difficile / Q000302:isolation & purification; D003082:Colectomy; D003428:Cross Infection / Q000517:prevention & control*; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery; D005060:Europe; D006801:Humans; D007362:Intensive Care Units; D008795:Metronidazole / Q000627:therapeutic use; D014481:United States; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D014640:Vancomycin