Infectious enterocolitis in the ICU

Abstract

Infectious enterocolitis is a rare cause of ICU admission but can develop during ICU stay. Infectious enterocolitis encompasses several mechanisms that should be known by clinicians. The diagnosis of colitis is based upon evidence of clinical colic signs (mainly diarrhea, abdominal pain) and confirmed by analysis of ultrasonography, computed tomography, and possibly digestive endoscopy. Infectious colitis should be distinguished from ischemic, toxic, and immunological enterocolitis. There are schematically four distinct contexts of infectious colitis in the ICU : communautary bacterial colitis (Campylobacter ; Salmonella; Shigella ; Yersinia ; E coli), nosocomial bacterial colitis (Clostridium difficile), neutropenic colitis, and CMV colitis. The evaluation of severity is based upon identification of organ failures and the search for intestinal damage. In particular, colectasy should be identified, with search for parietal thickening. Therapy is based upon etiological treatment directed against the bacteria or virus responsible for the colitis, the correction of organ failures, and possibly colectomy in case of fulminant colitis refractory to the medical treatment.