title: The efficacy of intracolonic vancomycin for severe Clostridium difficile colitis: a case series.
abstract: Clostridium difficile infection (CDI) unresponsive to the standard treatments of metronidazole and oral vancomycin requires aggressive medical management and possible surgical intervention including colectomy. Intracolonic vancomycin therapy has been reported to be particularly promising in the setting of severe CDI in the presence of ileus. This is a descriptive case series exploring the effect of adjunctive intracolonic vancomycin therapy on the morbidity and mortality in patients with moderate to severe CDI.
  
  
  
  A retrospective chart review was conducted on 696 patients with CDI seen at a single institution. Each patient was assigned a severity score and 127 patients with moderate to severe CDI were identified. We describe the clinical presentation, risk factors and hospital course comparing those that received adjunctive intracolonic vancomycin to those that only received standard therapy.
  
  
  
  The group that received adjunctive intracolonic vancomycin had higher rates of toxic megacolon, intensive care unit (ICU) admission, and colectomy, and yet maintained a similar mortality rate as the group that received only standard treatment.
  
  
  
  The intracolonic vancomycin group experienced more complications but showed a similar mortality rate to the standard therapy group, suggesting that intracolonic vancomycin may impart a protective effect. This study adds further evidence for the need of a randomized controlled study using intracolonic vancomycin as adjunctive therapy in patients presenting with severe CDI.
authors.affiliation: Department of Medicine, Loma Linda University School of Medicine, 11234 Anderson Street, Loma Linda, CA, 92354, USA.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Akamine
authors.affiliation: Department of Medicine, Loma Linda University School of Medicine, 11234 Anderson Street, Loma Linda, CA, 92354, USA.|Section of Infectious Disease, VA Loma Linda Healthcare System, 11201 Benton Street, Loma Linda, CA, 92357, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Ing
authors.affiliation: Department of Medicine, Loma Linda University School of Medicine, 11234 Anderson Street, Loma Linda, CA, 92354, USA.|Section of Gastroenterology, VA Loma Linda Healthcare System, 11201 Benton Street, Loma Linda, CA, 92357, USA.
authors.forename: Christian S
authors.initials: CS
authors.lastname: Jackson
authors.affiliation: Department of Medicine, Loma Linda University School of Medicine, 11234 Anderson Street, Loma Linda, CA, 92354, USA. LKLoo@llu.edu.
authors.forename: Lawrence K
authors.initials: LK
authors.lastname: Loo
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D016360:Clostridioides difficile; D003106:Colon; D004333:Drug Administration Routes; D004761:Enterocolitis, Pseudomembranous / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008532:Megacolon, Toxic / Q000139:chemically induced; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014640:Vancomycin / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D014640:Vancomycin
keywords: Clostridium difficile; Colitis; Intracolonic vancomycin; Mortality; Risk factors