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This combined approach and dosing strategy is based upon the rationale of ensuring effective delivery of therapeutic concentrations of antimicrobial therapy to the site of infection.
A major challenge in the management of severe, complicated CDI is the inability to predict in which patient medical therapy will fail, and lack of consensus on the indications or timing of surgery except the very rare complication of colonic perforation. The vague term clinical deterioration is frequently mentioned in already critically ill patients in whom medical therapy has failed.
These strategies rely on surgery as a salvage therapy, which may account for the poor outcomes associated with subtotal colectomy in complicated CDI, and mortality rates that range from 35 to 80 (38,39,41,42,65,72). Data reviewed in several series suggest that earlier colectomy (time from presentation to surgery) was associated with a significantly decreased mortality (40,73,74).