SEVERE INFECTIONS: Edited by Jean-François TimsitDiagnostic and therapy of severe Clostridioides difficile infections in the ICUGuery, Benoita,b,c,f; Barbut, Frédéricb,d,e,f; Tschudin-Sutter, Sarahf,gAuthor Information aInfectious Diseases Service, Department of Medicine, University Hospital and University of Lausanne, Lausanne, Switzerland bFrench Group of Faecal Microbiota Transplantation (GFTF) cEuropean Study Group on Host and Microbiota Interactions (ESGHAMI) dNational Reference Laboratory for Clostridium difficile eINSERM, U1139, Faculté de Pharmacie de Paris, Université Paris Descartes, UMR-S1139, Sorbonne Paris Cité, Paris, France fESCMID Study Group for Clostridioides difficile (ESGCD) gDivision of Infectious Diseases and Hospital Epidemiology and Department of Clinical Research, University Hospital Basel and University of Basel, Switzerland Correspondence to Benoit Guery, Infectious Diseases Service, Department of Medicine, University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland. Tel: +41 21 314 1643; e-mail: [email protected] Current Opinion in Critical Care: October 2020 - Volume 26 - Issue 5 - p 450-458 doi: 10.1097/MCC.0000000000000753 Buy Metrics Abstract Purpose of review The purpose of the review is to provide all the recent data focusing on the diagnostic and treatment of Clostridioides difficile infection in patients admitted in the ICU. Recent findings In the ICU, diagnosis remains complicated with a large number of alternative diagnosis. The treatment classically relies on vancomycin but fidaxomicin and fecal microbiota transplantation are now potential solutions in selected indications. Summary Data on ICU-related CDI remain limited and conflicting. To date, there is no unique and simple way to obtain a diagnosis for CDI, the combination of clinical signs and a two-step testing algorithm remains the recommended gold-standard. Two molecules can be proposed for first line treatment: vancomycin and fidaxomicin. Although metronidazole may still be discussed as a treatment option for mild CDI in low-risk patients, its use for ICU-patients does not seem reasonable. Several reports suggest that fecal microbiota transplantation could be discussed, as it is well tolerated and associated with a high rate of clinical cure. CDI is a dynamic and active area of research with new diagnostic techniques, molecules, and management concepts likely changing our approach to this old disease in the near future. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.