Introduction: Up to 15% of hospitalized patients with Clostridioides difficile infection (CDI) develop severe CDI (SCDI) or Fulminant CDI (FCDI). Due to high rates of mortality in medically-refractory CDI cases, 30% of patients with severe infection historically require surgical intervention. However, colectomy itself is an imperfect solution because it is difficult to predict who will fail medical therapy, patients with SCDI are more likely to have underlying medical conditions that make them poor surgical candidates, and post-surgical mortality still approaches 30-50%.Areas covered: This review will serve as a clinically-based review of severe and fulminant CDI management including discussion of models to predict severe infection, emerging treatments, novel targets for therapy, and innovations in surgical management.Expert opinion: Among the most promising studies to emerge in the last decade have involved fecal microbiota transplantation (FMT), which is already recommended by multiple society guidelines for recurrent CDI (RCDI). In the case of SCDI/FCDI, multiple studies have safely and successfully utilized FMT to produce rates of cure in the 70-90% range. Additionally, patients who have FCDI refractory to medical therapy and are poor candidates for colectomy may benefit from FMT as salvage therapy.

中文翻译：

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严重，暴发和难治的艰难梭菌感染的临床管理。

简介：住院的艰难梭菌感染（CDI）患者中，多达15％会发展为严重CDI（SCDI）或恶性CDI（FCDI）。由于难治性CDI病例的高死亡率，历史上30％的严重感染患者需要手术干预。但是，结肠切除术本身并不是一个完美的解决方案，因为很难预测谁将失败药物治疗，SCDI患者更有可能患有潜在的医学状况，使他们成为较差的手术候选人，而且手术后死亡率仍然接近30-50％。涵盖的领域：本次审查将作为对严重和暴发性CDI管理的基于临床的审查，包括讨论预测严重感染的模型，新出现的治疗方法，新颖的治疗目标以及手术管理的创新。过去十年中出现的最有前途的研究涉及粪便微生物菌群移植（FMT），这已被多个社会关于复发性CDI（RCDI）的指南所推荐。就SCDI / FCDI而言，多项研究已安全成功地利用FMT产生了70-90％的治愈率。此外，FCDI对药物治疗无效的患者和不适合进行结肠切除术的患者可从FMT抢救治疗中获益。