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Review
. 2025 May;109(3):721-734.
doi: 10.1016/j.mcna.2025.01.001. Epub 2025 Feb 21.

Fulminant Clostridioides difficile Infection: A Journey into the Unknown!

Jae H Shin  1 , Jasmine Y Jackson-Akers  2 , Sook C Hoang  3 , Brian W Behm  4 , Cirle A Warren  5
Affiliations
Review

Fulminant Clostridioides difficile Infection: A Journey into the Unknown!

Jae H Shin et al. Med Clin North Am. 2025 May.

Erratum in

  • Erratum.
    [No authors listed] [No authors listed] Med Clin North Am. 2026 Jan;110(1):xv. doi: 10.1016/j.mcna.2025.10.005. Med Clin North Am. 2026. PMID: 41206208 No abstract available.

Abstract

Clostridioides difficile is 1 of the 5 urgent antibiotic resistance threats in the United States as reported by the Centers for Disease Control and Prevention. Fulminant C difficile infection (CDI), characterized by hallmarks of critical illness such as hypotension, shock, or megacolon, has been difficult to define and treat. In this article, we describe the diagnostic criteria for fulminant CDI, clinical factors and inflammatory markers. We review the currently recommended treatment modalities including antibiotics and surgical interventions, colectomy, and diverting loop ileostomy. We also included treatment approaches that are still investigational such as intestinal microbiota transplant, tigecycline, and intravenous immunoglobulin.

Keywords: C difficile therapy; Fulminant C difficile infection; Severe complicated CDI; Toxic megacolon.

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Conflict of interest statement

Disclosures C.A. Warren is partially funded by NIH AI145322. C.A. Warren and B.W. Behm are UVA site investigators for Rebyota Observational Study Registry (ROAR, Ferring Pharmaceuticals). The rest of the authors have nothing to disclose.

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