RESUMEN
BACKGROUND: Clostridium difficile is the most common nosocomial infection in the United States. There is a subset of patients for whom medical therapy fails or who progress rapidly to the development of complicated disease, often marked by critical systemic illness. Patients with complicated Clostridium difficile infection (CDI) who progress or fail to improve benefit from surgery. RESULTS: This focused review highlights the importance of early surgical consultation for patients with complicated CDI, as well as emerging surgical therapy that does not involve resection of the colon but rather the creation of a loop ileostomy with colonic lavage, followed by antegrade vancomycin enemas into the colon during the post-operative period.
Asunto(s)
Clostridioides difficile , Infecciones por Clostridium/cirugía , Ileostomía , Antibacterianos/uso terapéutico , Infecciones por Clostridium/complicaciones , Infecciones por Clostridium/tratamiento farmacológico , Colectomía , Terapia Combinada , Infección Hospitalaria , Enema , Humanos , Irrigación Terapéutica , Vancomicina/uso terapéuticoRESUMEN
Clostridium difficile has become one of the main health care-associated infections. During the last decade increase in its incidence, recurrence, colectomy rate and mortality rate has made it necessary to establish the effectiveness of traditional therapies and has motivated the development of new therapies. New antibiotic treatments and alternative therapies have challenged management algorithms, especially in recurrent C. difficile infection. These include the fidaxomicin antibiotic which is selective against C. difficile and fecal microbiota transplantation. This review discussed therapies that are currently in use, their place in management algorithms and provides insight on developing therapies.
Clostridium difficile se ha convertido en una de las principales infecciones asociada a la atención de salud. El aumento en la última década de su incidencia, recurrencia, tasa de colectomía y mortalidad ha hecho necesario establecer la efectividad de las terapias tradicionalmente usadas y ha motivado el desarrollo de nuevas terapias. Nuevos tratamientos antibióticos, así como terapias alternativas a los antibióticos han desafiado los algoritmos de manejo, sobre todo en la infección por C. difficile recurrente. Entre éstos destacan el antibiótico fidaxomicina que es selectivo contra C. difficile y el trasplante de microbiota fecal. En esta revisión se analizan las terapias en uso actualmente, su lugar en los algoritmos de manejo y se dan luces sobre las terapias en desarrollo.
Asunto(s)
Humanos , Antibacterianos/uso terapéutico , Infecciones por Clostridium/tratamiento farmacológico , Infecciones por Clostridium/cirugía , Trasplante de Microbiota Fecal , Aminoglicósidos/uso terapéutico , Clostridioides difficile , Enterocolitis Seudomembranosa/tratamiento farmacológico , Enterocolitis Seudomembranosa/cirugíaRESUMEN
Three cases of emphysematous cholecystitis are presented. The role of hyperbaric oxygenation as excellent adjuvant therapy to urgent surgical as well as intensive conservative treatment is emphasized.
Asunto(s)
Colecistectomía , Colecistitis/cirugía , Infecciones por Clostridium/cirugía , Enfisema/cirugía , Oxigenoterapia Hiperbárica , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Colecistitis/diagnóstico , Colelitiasis/diagnóstico , Colelitiasis/cirugía , Infecciones por Clostridium/diagnóstico , Clostridium perfringens , Terapia Combinada , Enfisema/diagnóstico , Gangrena Gaseosa/diagnóstico , Gangrena Gaseosa/cirugía , Humanos , Masculino , Cuidados PosoperatoriosRESUMEN
In the realm of clinical practice, this disease entity defies applicability to any classification scheme. Of paramount importance is the early identification of all necrotizing soft-tissue infections. This requires a high index of suspicion, aided by recognition of various risk factors and organ system dysfunction out of proportion to the extent of local signs and symptoms. Expedient, aggressive surgical therapy is imperative: resuscitation, wide débridement, and antibiotic therapy. Once the infection has been controlled, continued supportive care, reconstruction, and rehabilitation can proceed.
Asunto(s)
Infección de la Herida Quirúrgica , Infecciones por Clostridium/diagnóstico , Infecciones por Clostridium/tratamiento farmacológico , Infecciones por Clostridium/cirugía , Extremidades/microbiología , Humanos , Oxigenoterapia Hiperbárica , Necrosis , Perineo/microbiología , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/tratamiento farmacológico , Infecciones Estreptocócicas/cirugía , Infección de la Herida Quirúrgica/diagnóstico , Infección de la Herida Quirúrgica/tratamiento farmacológico , Infección de la Herida Quirúrgica/cirugíaRESUMEN
Clostridial infections, particularly myonecrosis, can be fulminant and fatal; they often arise without an obvious history of trauma. The cardinal diagnostic clues (Figure 3) must be recognized so that specific therapy can be initiated promptly and mortality can be minimized. Aggressive medical care, including crystalloid fluid therapy and antibiotics, must be initiated quickly. Vasopressors should be avoided. Antitoxin has no role in contemporary care. Early hyperbaric oxygenation is beneficial, but it should be preceded by decompressive fasciotomy if limb edema is marked. Otherwise, definitive debridement or amputation is best delayed until after hyperbaric therapy is begun. Regionalization of care and long transport times also must be considered seriously in determining the therapeutic approach.
Asunto(s)
Infecciones por Clostridium , Amputación Quirúrgica , Animales , Antibacterianos/uso terapéutico , Quemaduras/complicaciones , Infecciones por Clostridium/diagnóstico , Infecciones por Clostridium/epidemiología , Infecciones por Clostridium/etiología , Infecciones por Clostridium/mortalidad , Infecciones por Clostridium/fisiopatología , Infecciones por Clostridium/cirugía , Infecciones por Clostridium/terapia , Desbridamiento , Fluidoterapia , Humanos , Oxigenoterapia Hiperbárica , Inyecciones Intramusculares/efectos adversos , Dolor , Taquicardia , Transporte de Pacientes , Estados Unidos , Heridas y Lesiones/complicacionesRESUMEN
Two newborns had necrotizing enterocolitis (NEC) and severe hemolytic anemia. Clostridium perfringens was identified in the peritoneal fluid of both infants, supporting the previous association of C perfringens with hemolysis reported in adult patients. Infants with NEC and hemolytic anemia should be aggressively treated with surgical debridement and high-dose parenteral penicillin G potassium. Similarly, Gram's stain of peritoneal fluid and resected bowel at laparotomy for NEC may be useful for early identification of the primary organism.