title: Successful treatment of severe Clostridium difficile infection by administration of crushed fidaxomicin via a nasogastric tube in a critically ill patient.
abstract: OBJECTIVE
  To report the successful use of crushed fidaxomicin via a nasogastric tube for treatment of a severe Clostridium difficile infection in a critically ill patient.
  
  
  METHODS
  Clinical observation of a patient, images of abdominal computed tomography, antimicrobial therapy and course of infection parameters.
  
  
  METHODS
  Relevant information contained in the medical observation of the patient and selection of image and laboratory parameters performed in the patient.
  
  
  RESULTS
  We report a case of a 79-year old patient who developed septic shock with an increasing need for norepinephrine and acute renal failure due to a severe Clostridium difficile infection. Antimicrobial therapy with vancomycin via a nasogastric tube and metronidazole i.v. did not lead to improvement, infection parameters further increased, and the clinical condition became increasingly impaired. After 10 days, antimicrobial therapy was changed to fidaxomicin, crushed and administered via nasogastric tube. Within 24hours, infection parameters decreased. Further diarrhoea ceased and stool samples were negative for Clostridium difficile antigen.
  
  
  CONCLUSIONS
  Our case confirms that administration of fidaxomicin via a nasogastric tube was safe and effective in this patient. Further studies are needed to evaluate the efficacy of this strategy in critically ill patients systematically.
authors.affiliation: Department of Anaesthesiology and Operative Intensive Care Medicine, Witten/Herdecke University, Cologne Merheim Medical Centre, Germany. Electronic address: sven.arends@me.com.
authors.forename: Sven
authors.initials: S
authors.lastname: Arends
authors.affiliation: Department of Anaesthesiology and Operative Intensive Care Medicine, Witten/Herdecke University, Cologne Merheim Medical Centre, Germany. Electronic address: defossej@kliniken-koeln.de.
authors.forename: Jerome
authors.initials: J
authors.lastname: Defosse
authors.affiliation: MVZ synlab Leverkusen GmbH, Leverkusen, Germany. Electronic address: cori.diaz@synlab.com.
authors.forename: Cori
authors.initials: C
authors.lastname: Diaz
authors.affiliation: Department of Anaesthesiology and Operative Intensive Care Medicine, Witten/Herdecke University, Cologne Merheim Medical Centre, Germany. Electronic address: wapplerf@kliniken-koeln.de.
authors.forename: Frank
authors.initials: F
authors.lastname: Wappler
authors.affiliation: Department of Anaesthesiology and Operative Intensive Care Medicine, Witten/Herdecke University, Cologne Merheim Medical Centre, Germany. Electronic address: sakkas@kliniken-koeln.de.
authors.forename: Samir G
authors.initials: SG
authors.lastname: Sakka
mesh_terms: D000368:Aged; D000617:Aminoglycosides / Q000008:administration & dosage* / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D016360:Clostridioides difficile; D016638:Critical Illness; D003967:Diarrhea / Q000188:drug therapy; D004761:Enterocolitis, Pseudomembranous / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D000077732:Fidaxomicin; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000379:methods*; D012772:Shock, Septic / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D000077732:Fidaxomicin
keywords: Antibiotic treatment-associated diarrhoea; Clostridium difficile; Critical illness; Nasogastric tube; Sepsis; fidaxomicin