Pseudomembranous colitis and toxic megacolon due to C. difficile in an inpatient hospitalized for home accident

Piergiorgio Chiriacò

DOI: https://doi.org/10.7175/cmi.v9i1S.1158

Abstract

Clostridium difficile infection (CDI) is the main cause of hospital-acquired diarrhea. It can result in symptoms ranging from moderate diarrhea to pseudomembranous colitis. Among the risk factors, there is antibiotic therapy, responsible for intestinal flora disruption.

A 72-year-old man presented to the Emergency Room for a home accident, a fall, that resulted in a cranio-facial trauma and tibio-tarsal fracture. He was administered cefazolin. Then he underwent surgery and the antibiotic therapy was switched to teicoplanin + levofloxacin; three days after, he started having diarrhea and mild fever. Rifaximin was added. A further exacerbation prompted the replacement of antibiotic therapy with tazobactam-piperacillin and metronidazole. Owing to the detection in fecal examination of CDI signs, tazobactam-piperacillin were replaced with vancomicin. Due to the persistence of symptoms, the worsening of physical conditions and the onset of pseudomembranous colitis and toxic megacolon, fidaxomicin therapy was started, with symptom resolution in few days. A patient’s follow-up at five months post-treatment showed no CDI recurrence.

Keywords

Pseudomembranous colitis; Toxic megacolon; Clostridium difficile; Trauma; Fidaxomicin

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References

  • Elliott B, Chang BJ, Golledge CL, et al. Clostridium difficile-associated diarrhoea. Intern Med J 2007; 37: 561-8; http://dx.doi.org/10.1111/j.1445-5994.2007.01403.x
  • McFarland LV. Update on the changing epidemiology of Clostridium difficile-associated disease. Nat Clin Pract Gastroenterol Hepatol 2008; 5: 40-8; http://dx.doi.org/10.1038/ncpgasthep1029
  • Aldeyab MA, Harbarth S, Vernaz N, et al. Quasi experimental study of the effects of antibiotic use, gastric acid-suppressive agents, and infection control practices on the incidence of Clostridium difficile-associated diarrhea in hospitalized patients. Antimicrob Agents Chemother 2009; 53: 2082-8; http://dx.doi.org/10.1128/AAC.01214-08
  • Thomas C, Stevenson M, Riley TV. Antibiotics and hospital-acquired Clostridium difficile-associated diarrhoea: a systematic review. J Antimicrob Chemother 2003; 51: 1339-50; http://dx.doi.org/10.1093/jac/dkg254
  • Vernaz N, Hill K, Leggeat S, et al. Temporal effects of antibiotic use and Clostridium difficile infections. J Antimicrob Chemother 2009; 63: 1272-5; http://dx.doi.org/10.1093/jac/dkp128
  • Owens RC Jr, Donskey CJ, Gaynes RP, et al. Anti-microbial-associated risk factors for Clostridium difficile infection. Clin Infect Dis 2008; 46 (Suppl. 1): S19-S31; http://dx.doi.org/10.1086/521859
  • Pépin J, Saheb N, Coulombe MA, et al. Emergence of fluoroquinolones as the pre-dominant risk factor for Clostridium difficile-associated diarrhea: a cohort study during an epidemic in Quebec. Clin Infect Dis 2005; 41: 1254-60; http://dx.doi.org/10.1086/496986
  • Debast SB, Bauer MP, Kuijper EJ. European Society of Clinical Microbiology and Infectious Diseases: update of the treatment guidance document for Clostridium difficile infection. European Society of Clinical Microbiology and Infectious Diseases. Clin Microbiol Infect 2014; 20 (Suppl 2): 1-26; http://dx.doi.org/10.1111/1469-0691.12418; http://dx.doi.org/10.1111/1469-0691.12418
  • Drekonja DM, Butler M, MacDonald R, et al. Comparative effectiveness of Clostridium difficile treatments: a systematic review. Ann Intern Med 2011; 155: 839-47; http://dx.doi.org/10.7326/0003-4819-155-12-201112200-00007
  • Cornely OA, Crook DW, Esposito R, et al; OPT-80-004 Clinical Study Group. Fidaxomicin versus vancomycin for infection with Clostridium difficile in Europe, Canada, and the USA: a double-blind, non-inferiority, randomised controlled trial. Lancet Infect Dis 2012; 1-9; http://dx.doi.org/10.1016/S1473-3099(11)70374-7
  • Wilcox MH. Progress with a difficult infection. Lancet Infect Dis 2012; 12: 256-7; http://dx.doi.org/10.1016/S1473-3099(12)70013-0

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