Clostridium difficile: An update

Gonenne, Jonathan; Pardi, Darrell S.

doi:10.1007/s12019-004-0009-z

Cited by 4 publications

(9 citation statements)

References 76 publications

(105 reference statements)

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“…or 250 mg q.i.d. for 10 days 18. Besides antibiotic therapy, restoration of beneficial intestinal flora with probiotics may suppress the abnormal overgrowth of C. difficile and thus ameliorate the course of the disease.…”

Section: Discussionmentioning

confidence: 99%

Rifampin-induced Pseudomembranous Colitis with Rectosigmoid Sparing

et al. 2011

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Pseudomembranous colitis (PMC) is known to be associated with antibiotic treatment, but is not commonly related to antitubercular (anti-TB) agent, rifampin. PMC is frequently localized to rectum and sigmoid colon, which can be diagnosed with sigmoidoscopy. We report a case of rifampin-induced PMC with rectosigmoid sparing in a pulmonary tuberculosis patient. An 81-year-old man using anti-TB agents was admitted with a 30-day history of severe diarrhea and general weakness. On colonoscopy, nonspecific findings such as mucosal edema and erosion were found in sigmoid colon, whereas multiple yellowish plaques were confined to cecal mucosa only. Biopsy specimen of the cecum was compatible with PMC. Metronidazole was started orally, and the anti-TB medications excluding rifampin were readministerred. His symptoms remarkably improved within a few days without recurrence. Awareness of rectosigmoid sparing PMC in patients who develop diarrhea during anti-TB treatment should encourage early total colonoscopy.

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Section: Discussionmentioning

confidence: 99%

Rifampin-induced Pseudomembranous Colitis with Rectosigmoid Sparing

et al. 2011

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“…difficile colitis is characterized by profuse watery diarrhea (90% to 95%), crampy abdominal pain (80% to 90%), and fever and leukocytosis (80% each). 3,6,7,17 Bloody diarrhea is distinctly uncommon; its occurrence should trigger a search for inflammatory bowel disease or other colitides. Nonspecific malaise is often present.…”

Section: Clinical Presentation and Diagnosismentioning

confidence: 99%

“…In the United States, treatment with either metronidazole (500 mg orally three times a day for 10 to 14 days) or vancomycin (125 mg orally four times a day for 7 days) is recommended. 3,6,7,17,20 Metronidazole should be the initial agent of choice; it is cheaper and more versatile than vancomycin because intravenous metronidazole is effective against C. difficile and parenteral vancomycin is not. In addition, the emergence of vancomycin-resistant enterococcus strains supports limiting use of vancomycin to patients in whom initial treatment with metronidazole has failed.…”

Section: Medical Treatment Of Pseudomembranous Colitismentioning

confidence: 99%

“…27 SURGICAL TREATMENT OF PSEUDOMEMBRANOUS COLITIS Surgery for C. difficile colitis is seldom indicated, being required in only 0.4% to 5% of cases. 17 Surgery is reserved for complications of the disease such as fulminant colitis unresponsive to medical treatment, toxic megacolon, and free perforation. [28][29][30][31][32][33][34] Approximately 3% to 20% of patients with PMC develop systemic signs of sepsis with fever, tachycardia, and leukocytosis.…”

Section: Medical Treatment Of Pseudomembranous Colitismentioning

confidence: 99%

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Clostridium difficile Colitis

Trudel

2007

Clinics in Colon and Rectal Surgery

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Clostridium difficile enterocolitis is endemic in most modern hospitals. The spectrum of clinical presentation varies from the asymptomatic carrier state to fulminant colitis with toxic megacolon and perforation. Highly toxigenic and lethal strains of C. difficile have emerged worldwide. Medical treatment consists of discontinuing the precipitating antibiotic, supportive measures and bowel rest, and antibiotic treatment with metronidazole or vancomycin. Surgical treatment may be necessary in cases of fulminant disease. Subtotal colectomy with end ileostomy is the operation of choice.

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“…6 The spectrum of CDI ranges from mild diarrhea to pseudomembranous colitis and toxic megacolon and from sepsis to death. [7][8][9] Although the infection is usually localized to the gastrointestinal tract, significant bacteremia may also occur. 10,11 The management of CDI varies from discontinuation of predisposing factors (i.e., antibiotics) to use of direct therapy against C. difficile including metronidazole, vancomycin, rifaximin, and fidaxomicin.…”

mentioning

confidence: 99%

Patience is a Virtue: An Argument for Delayed Surgical Intervention in Fulminant Clostridium difficile Colitis

Clanton

Fawley

Haller³

et al. 2014

The American Surgeon™

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Recently, the incidence and severity of Clostridium difficile infection (CDI) has increased. In cases of fulminant infection, surgery is a viable therapeutic option but associated with high mortality. We sought to examine factors associated with mortality in a large sample of patients with severe CDI that underwent surgery. A retrospective study was conducted in patients with severe CDI undergoing colectomy. Demographics, risk factors, comorbidities, clinical and laboratory data, and time between admission/diagnosis of CDI and colectomy were collected. Conventional markers of severity were evaluated as predictors of mortality. Sixty-four cases were included for analysis. The overall observed mortality rate was 45.3 per cent. Few conventional markers of severity were significantly associated with mortality. Risk factors that correlated with postsurgical mortality were vasopressor use (odds ratio, 3.08; 95% confidence interval, 1.00 to 9.92) and shorter time between diagnosis and surgery (median time, 2 vs 3 days, P = 0.009). This study suggests that a delay in surgery after diagnosis of severe CDI may improve overall outcomes. The finding regarding timing of surgery is contrary to traditional teaching and may be the result of improved medical treatment and stabilization before surgery. Consideration should be given to the importance of timing of colectomy in fulminant CDI, whereas prospective studies should be conducted to elucidate causal relationships.

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Clostridium difficile: An update

Abstract: Clostridium difficile causes a spectrum of diarrheal illness with the potential for major medical consequences. Although most cases respond quickly to treatment, C. difficile colitis may be severe and life threatening. Recurrent disease represents a particularly challenging problem.

Cited by 4 publications

References 76 publications

Rifampin-induced Pseudomembranous Colitis with Rectosigmoid Sparing

Rifampin-induced Pseudomembranous Colitis with Rectosigmoid Sparing

Clostridium difficile Colitis

Patience is a Virtue: An Argument for Delayed Surgical Intervention in Fulminant Clostridium difficile Colitis

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