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Surgical infection
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Clostridium difficile is the cause of pseudomembranous colitis, where destruction of the normal colonic bacterial flora by antibiotic therapy allows an overgrowth of the normal gut commensal C. diff to pathological levels. Any antibiotic may cause this phenomenon, although the quinolones such as ciprofloxacin seem to be the highest risk, especially in elderly or immunocompromised patients. In its most severe form, the colitis may lead to perforation and the need for emergency colectomy with an associated high mortality. Treatment involves resuscitation and antibiotic therapy with metronidazole or vancomycin. The fibrinous exudate is typical and differentiates the colitis from other inflammatory diseases; laboratory recognition of the toxin is an early accurate diagnostic test.
Answers
Published in John D Firth, Professor Ian Gilmore, MRCP Part 2 Self-Assessment, 2018
John D Firth, Professor Ian Gilmore
Approximately 20% of patients with pseudomembranous colitis relapse, usually 2 weeks to 2 months after treatment. This is related to the persistence of C.difficile spores that are not killed by antibiotic therapy, rather than to metronidazole resistance, hence recurrence of disease should be treated with a second course of oral metronidazole. If he fails to respond to a second course of oral metronidazole then the second line agent would be oral (not intravenous) vancomycin.
Diarrhoea
Published in Sherif Gonem, Ian Pavord, Diagnosis in Acute Medicine, 2017
Pseudomembranous colitis is a severe form of Clostridium difficile infection. It is treated with oral metronidazole or vancomycin according to local guidelines. Early surgical review should be sought, as some cases progress to toxic megacolon with possible bowel perforation.
Increased risk of inflammatory bowel disease among patients treated with rituximab in Iceland from 2001 to 2018
Published in Scandinavian Journal of Gastroenterology, 2021
Valdimar B. Kristjánsson, Sigrún H. Lund, Gerður Gröndal, Signý V. Sveinsdóttir, Hjálmar R. Agnarsson, Jón G. Jónasson, Einar S. Björnsson
Two cases were classified as indeterminate IBD, as they never received a definitive diagnosis during the study period. In these cases, the patients underwent several colonoscopies, but the biopsies were not consistent with either ulcerative colitis or Crohn’s disease. One case, a 55-year-old male who developed severe gastrointestinal symptoms – including abdominal pain and watery diarrhoea up to 15 times per day – who finally required an ileostomy to relieve his colitis. He underwent a total of six colonoscopies. The pathological examination showed features of pseudomembranous colitis but also displayed features of bacterial colitis, ischemic colitis, and drug-induced colitis. Cultures for Clostridium difficile, other bacteria, viruses, and parasites known to lead to colitis were repeatedly negative. The endoscopic picture consisted of severe erythema and swelling of the mucosa with an absence of any vascular pattern and in some endoscopies revealed inflammatory polyps and prolific mucous. Macroscopically, the mucosa did not show signs of ‘pseudomembranous colitis’ as seen with C. difficile. However, pseudomembranous colitis is not only caused by C. difficile and can be seen in both drug-induced colitis and colitis caused by other pathogens [20].
Bacterial external ventricular catheter-associated infection
Published in Expert Review of Anti-infective Therapy, 2020
Kirsten R. I. S. Dorresteijn, Matthijs C. Brouwer, Korné Jellema, Diederik van de Beek
In a study comparing antibiotic-impregnated catheters with conventional catheters coupled with systemic antibiotics, 184 patients with an EVD were assigned to one of both treatment groups. In the group with prolonged systemic antibiotics (n = 94), three cases of pseudomembranous colitis occurred vs none in the group with antibiotic-impregnated catheters. The number of pneumonias, urinary tract infections, and septicemias did not statistically differ between the two groups [49]. In a multicenter retrospective study including 462 consecutive adult patients in three different French hospitals, an EVD care protocol was implemented. In one of the three participating hospitals, amikacin 10 mg was administered intraventricularly 1 h prior to EVD removal and daily CSF-sampling was performed. This led to a lower mean cumulative incidence of EVD-related infections at this site (1.4% [95% CI 0.0%-2.9%]) vs 9.2% [95% CI 4.2%-14.2%] and 7.2% [95% CI 2.4%-12.0%]) [67]. Altogether, no firm conclusions can be drawn on the additional effect of periprocedural and prolonged antibiotic prophylaxis in reducing the infection rate and whether it outweighs the risk of selection for resistant pathogens.
The role of trehalose in the global spread of epidemic Clostridium difficile
Published in Gut Microbes, 2019
James Collins, Heather Danhof, Robert A. Britton
Clostridium difficile infection (CDI) is the leading cause of hospital associated infection in the developed world. Symptoms range from mild diarrhea to life threatening pseudomembranous colitis. The Clostridium difficile species is composed of hundreds of genetic lineages (also known as ribotypes), though only a small number are responsible for the majority of infections.1 We have recently shown that two epidemic ribotypes, RT027 and RT078, have evolved novel methods to metabolise low levels of trehalose.2 A disaccharide of glucose, trehalose was introduced to the food chain en masse during the early 2000s following a precipitous drop in manufacturing costs and “generally regarded as safe” (GRAS) status in the USA and Europe. In this addendum we expand on the ideas put forth in our prior publication and provide new data on a third epidemic ribotype, RT017, that is frequently found in Asia and Europe.