Diagnostik und Therapie von Clostridium-difficile-Infektionen auf deutschen Intensivstationen - eine Umfrage unter Intensivmedizinern

Translated title of the contribution: Management of Clostridium difficile infections at German intensive care units - Results from a survey among intensivists

Jan Bruensing, Lukas Buendgens, Christoph Jochum, Ulf Herbers, Ali Canbay, Georg Braun, Christian Trautwein, Wolfgang Huber, Alexander Koch, Frank Tacke

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Background Clostridium difficile associated colitis is a frequent cause of nosocomial diarrhea at the intensive care unit (ICU) and is associated with poor prognosis in critically ill patients. Few studies have evaluated the efficacy of treatment options or adherence to guideline recommendations of Clostridium difficile infections at the ICU. Methods Therefore, on behalf of the Gastroenterology Intensive Care Medicine working group of the DGVS, we have conducted an online-based survey among leading intensivists in Germany. Results Out of the 351 invited, 85 (24.2%), primarily leading executive physicians at primary to tertiary care hospitals, completed the survey. They reported standardized diagnostic algorithms of 79.3%, in line with current guideline recommendations (i.e., toxin testing in stool, possibly GDH screening, and endoscopy). First-line therapy of Clostridium difficile infections at the ICU was reported to be oral vancomycin in 48.3% and oral metronidazole in 34.5%. The success of first-line therapy was estimated at 67% for clinical cure, 15% persisting colitis, 5% sepsis or megacolon, 10% recurrence, and 3% death. Hospitals of primary/secondary care more often used metronidazole compared to university hospitals. Standard treatments for recurrent infection were vancomycin orally (40% alone, 29.1% combined with metronidazole) or, more rarely, fidaxomicin (25.5%). Fidaxomicin has been used at least once at the ICU in 79% of the respondents. Eleven percent have used fecal microbiota transplant (FMT) in selected cases at the ICU. Conclusion Our survey indicated a high awareness of German intensivists for Clostridium difficile infections, but also marked differences in local therapeutic algorithms, especially in first-line treatment.

Translated title of the contributionManagement of Clostridium difficile infections at German intensive care units - Results from a survey among intensivists
Original languageGerman
Pages (from-to)551-560
Number of pages10
JournalZeitschrift fur Gastroenterologie
Volume56
Issue number6
DOIs
StatePublished - 1 Jun 2018
Externally publishedYes

Keywords

  • ICU
  • clostridium
  • fecal microbiota transfer
  • pseudomembraneous colitis
  • survey
  • therapy

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