"Most have required months to recover from the illness that brought them into the hospital in the first place, which often wasn’t C. difficile. We wait until they’re back on their feet again," Dr. Zuckerbraun explained.
The indications for temporary loop ileostomy and colonic lavage are, first, diagnosis of C. difficile colitis by toxin assay, a compatible CT scan, or endoscopic findings, along with any one of the following criteria: sepsis, peritonitis, change in mental status, ventilatory failure, vasopressor requirement, worsening abdominal pain or distention, or unexplained clinical deterioration, he said.
At the urging of medical intensivists and transplant physicians, the investigators have also performed this operation in two patients with multiple recurrent episodes of C. difficile colitis who were not critically ill. One patient had 19 prior episodes. The C. difficile was successfully eradicated in both cases. The new procedure, however, was undertaken only after the patients failed a trial of high-volume propylene glycol lavage by nasogastric tube, which the investigators have previously employed successfully to eradicate C. difficile infections in several other patients with multiply recurrent nonfulminant colitis.
Severe, complicated C. difficile colitis occurs in 4%-10% of C. difficile-associated disease, which is now the most common nosocomial infection.
Dr. Zuckerbraun reported no conflicts of interest.