Role of surgery in antibiotic-induced pseudomembranous enterocolitis

Morris, Jon B.; Zollinger, Robert M.; Stellato, Thomas A.

doi:10.1016/s0002-9610(05)81024-4

Cited by 113 publications

(67 citation statements)

References 31 publications

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“…45,48 Mortality associated with toxic megacolon is high, ranging from 24% to 38%. [49][50][51][52] Recurrent diarrhea is seen in 5%-40% of patients receiving treatment for C. difficile diarrhea. [53][54][55][56] Kyne and associates showed that independent risk factors for recurrent C. difficile diarrhea include age greater than 65 years, increased severity of underlying disease and exposure to additional antibiotics after treatment.…”

Section: Clinical Presentationmentioning

confidence: 99%

Clostridium difficile-associated diarrhea in adults

Poutanen

Simor²

2004

Canadian Medical Association Journal

358

280

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CLOSTRIDIUM DIFFICILE is the most important cause of nosocomial diarrhea in adults. Illness may range from mild watery diarrhea to life-threatening colitis. An antecedent disruption of the normal colonic flora followed by exposure to a toxigenic strain of C. difficile are necessary first steps in the pathogenesis of disease. Diagnosis is based primarily on the detection of C. difficile toxin A or toxin B. First-line treatment is with oral metronidazole therapy. Treatment with oral vancomycin therapy should be reserved for patients who have contraindications or intolerance to metronidazole or who fail to respond to first-line therapy

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Section: Clinical Presentationmentioning

confidence: 99%

Clostridium difficile-associated diarrhea in adults

Poutanen

Simor²

2004

Canadian Medical Association Journal

358

280

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“…abdominal cramping (80-90%), fever (80%), leukocytosis (80%) and, rarely, vomiting [13,95]. Most patients with PMC become symptomatic within 1 week after antibiotic exposure, but symptoms may be delayed in as many as…”

Section: Miscellaneous Etiologiesmentioning

confidence: 99%

“…40% of patients for 2-8 weeks after antibiotics have been discontinued [95]. Complications of PMC may include AAD has a spectrum of severity including uncomplicated diarrhea, colitis and PMC.…”

Section: Clinical Featuresmentioning

confidence: 99%

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Epidemiology, Risk Factors and Treatments for Antibiotic-Associated Diarrhea

McFarland

1998

Dig Dis

275

195

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Antibiotic-associated diarrhea (AAD) is a common complication of antibiotics and recent findings on the epidemiology, etiologies and treatment strategies are reviewed. Rates of AAD vary from 5 to 39% depending upon the specific type of antibiotic. The severity of AAD may include uncomplicated diarrhea, colitis or pseudomembranous colitis. The pathogenesis of AAD may be mediated through the disruption of the normal flora and overgrowth of pathogens or through metabolic imbalances. The impact of AAD is reflected by increased hospital stays, higher medical costs and increased rates of comorbidity. The key to decreasing these consequences is prompt diagnosis followed by effective treatment and institution of control measures.

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“…96%-100% of pseudomembranous colitis cases, 60%-75% of antibiotic-associated colitis cases, and 11%-33% of cases with diarrhea due to antibiotic intake are associated with C. difficile [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42].…”

Section: Discussionmentioning

confidence: 99%

Pseudomemberanous Colitis following Cesarean Delivery with Adjunctive Intracolonic Vancomycin

Ahmadi¹,

Rezaee²,

Tanha³

et al. 2016

J Gynecol Res Obstet

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Journal of Gynecological Research and Obstetrics 055According to the operation report numerous adhesions were detected during surgery, many of which especially those in the uterine incision site had been released. The patient received one dose of prophylactic cefazolin after clamping of the umbilical cord. Before discharge (discharged with personal consent) she had gas passage and defecation.Three days after C/S the patient was hospitalized with a presumed ileus. At that point she seemed well and had no fever and tachycardia; the abdomen was distended; bowel sounds were normal. On palpation, tenderness in left lower quadrant without rebound was present. In chest auscultation no abnormal finding except dextrocardia was detected (Figures 1,2).Initially the patient was managed conservatively, laboratory tests and surgery consult were ordered.The patient was not allowed to take anything by mouth and it was well emphasised to her to stay mobile. Despite gas passage her abdominal distention fluctuated during the first two days of hospitalization. During this period the laboratory findings were normal, no leucocytosis was present and hemoglobin and electrolytes were normal. Just on abdominal x ray( upright and flat) hyperinflation was to be seen.After the second day, diarrhea and a 38 C fever were added to the patients' signs. The diarrhea contained greenish liquid with white cheese -like parts. The patient was not ill, the abdominal palpation revealed no change and the laboratory findings were still normal.On the third day, abdominal distention was noticeably increased and the abdomen became tenser. Emergent surgery and gastrointestinal consult were ordered and the patient was admitted to the intensive care unit. At that point potassium was as low as 2.4 IntroductionPseudomembranous colitis (PMC) is a type of colitis (and sometimes enteritis), with special pathologic and oftentimes radiologic features, which is usually associated with the overgrowth of a bacterium called Clostridium difficile. Although this condition normally occurs following antibiotic consumption, it may rarely happen in other settings such as bowel ischemia, intestinal obstruction, and intestinal surgery or chemotherapy. Moreover, gastrointestinal infections (e.g. Staphylococcus aureus) can induce a similar condition [1].A recent increase in the incidence rate and severity of clostridium difficile infection has been reported, which is thought to be due to the great use of broad spectrum antibiotics worldwide and the development of a hypervirulant strain of this organism [2][3][4]. The presentation of PMC can vary from a self-limiting diarrhea to toxic megacolon and death [5]. Yet, many cases have confusing clinical features and their condition may not be diagnosed immediately [1]. History of previous antibiotic intake especially cephalosporins and flouroquinolones is the most important risk factor for PMC [6][7][8]. This risk is at its peak within the first month after antibiotic use [9].Immediate diagnosis and treatment of this condition can decre...

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Role of surgery in antibiotic-induced pseudomembranous enterocolitis

Cited by 113 publications

References 31 publications

Clostridium difficile-associated diarrhea in adults

Clostridium difficile-associated diarrhea in adults

Epidemiology, Risk Factors and Treatments for Antibiotic-Associated Diarrhea

Pseudomemberanous Colitis following Cesarean Delivery with Adjunctive Intracolonic Vancomycin

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