From the Guidelines
Yes, Clostridioides difficile (C. diff) colitis can cause sepsis.
Sepsis in C. diff Colitis
- C. diff colitis can lead to severe complications, including toxic megacolon, peritonitis, and septic shock 1.
- The development of sepsis in C. diff colitis is often associated with systemic symptoms, such as fever, leukocytosis, and hypoalbuminemia 1.
- Fulminant colitis is a severe form of C. diff colitis that can progress to multiple organ failure and increased mortality 1.
Risk Factors for Sepsis
- Leukocytosis (WBC > 15 × 10^9/L) and renal failure are useful predictors of severe C. diff colitis and sepsis 1.
- Hypoalbuminemia (albumin < 2.5 g/dL) is also a predictor of severe C. diff colitis and sepsis, as human serum albumin can bind C. difficile toxin A and B, impairing their internalization into host cells 1.
Management of Sepsis in C. diff Colitis
- Early diagnosis and treatment are crucial in reducing mortality associated with fulminant colitis and sepsis 1.
- Surgical management may be necessary in cases of fulminant colitis with systemic toxicity, and resection of the entire colon should be considered in these cases 1.
- Diverting loop ileostomy with colonic antibiotic lavage is an effective alternative to subtotal colectomy in some cases 1.
From the Research
C. diff Colitis and Sepsis
- C. diff colitis can cause sepsis, as reported in several studies 2, 3, 4
- The mechanism of sepsis may be related to the derangement of the gastrointestinal barrier function, leading to absorption of microbes or endotoxin, or activation of inflammatory cascades 2
- Severe C. diff infection can result in death, and treatment includes management of severe sepsis and shock, pathogen-directed antibiotic therapy, and surgical intervention in selected cases 3
Clinical Presentations
- C. diff infection can present with a range of symptoms, from self-limiting diarrhea to fulminant disease, including toxic megacolon or pseudo-membranous colitis 5, 6
- Septic shock from C. diff colitis can occur even in healthy individuals without traditional risk factors 4
- Accurate diagnosis of C. diff infection depends on selecting patients with high pre-test probability, collecting an acceptable stool specimen, and understanding current test methods 5