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Even vancomycin monotherapy may no longer be sufficient in the deteriorating patient. Although one study from Spain suggested that drug resistance was a contributing factor, 22 this pattern of antibiotic resistance has not been verified in the United States.
With severe disease that does not respond to therapy, urgent surgical intervention is of critical importance. The researchers evaluated both patients with CDAD requiring ICU placement and ICU patients whose CDAD was severe enough by itself to require critical care. The primary indications for surgery were perforation, shock resistant to pressor therapy, toxic megacolon, and failure to respond to medical therapy.