Efficacy of fidaxomicin therapy, after failure of vancomycin therapy, for treating a C. difficile colitis in a patient with ulcerative colitis

Carlo Tascini, Federico Corti, Gualtiero Bottari, Paola Lambelet

DOI: https://doi.org/10.7175/cmi.v9i1S.955

Abstract

Patients with inflammatory bowel diseases (IBDs) have greater risk of developing C. difficile infection (CDI). In these patients, CDI have worse outcome, may be associated with increased risk of bacteremia and candidemia and may be misdiagnosed as relapse of IBD, also because ofthe absence of typical findings of CDI at colonoscopy.

A 58-year-old man with acute ulcerative colitis treated with steroids was hospitalized for feverand recrudescence of inflammatory diarrhea. During the hospitalization, the fever was treated with broad spectrum antibiotics and systemic anti-fungal therapy. Candida mannan antigenand the molecular screening for C. difficile resulted positive. A first course of vancomycin by mouthwas unsuccessful, therefore we started a 10-day course of fidaxomicin. After five days of therapy, diarrhea disappeared. A few-week course of fluconazole therapy was performed to complete the treatment of invasive candidiasis. At six-month follow-up no relapse of CDI was documented.

Keywords

Clostridium difficile colitis; Inflammatory bowel disease; Fidaxomicin; Ulcerative colitis

Full Text

HTML PDF

References

  • Kaakoush NO, Day AS, Huinao KD, et al. Microbial dysbiosis in pediatric patients with Crohn's disease. J Clin Microbiol 2012; 50: 3258-66; http://dx.doi.org/10.1128/JCM.01396-12
  • Frank DN, St Amand AL, Feldman RA, et al. Molecular-phylogenetic characterization of microbial community imbalances in human inflammatory bowel diseases. Proc Natl Acad Sci USA 2007; 104: 13780-5; http://dx.doi.org/10.1073/pnas.0706625104
  • Kelly CP, LaMont JT. Clostridium difficile infection. Annu Rev Med 1998; 49: 375-90; http://dx.doi.org/10.1146/annurev.med.49.1.375
  • Ananthakrishnan AN, McGinley EL, Binion DG. Excess hospitalisation burden associated with Clostridium difficile in patients with inflammatory bowel disease. Gut 2008; 57: 205-10; http://dx.doi.org/10.1136/gut.2007.128231
  • Ananthakrishnan AN, McGinley EL, Saeian K, et al. Temporal trends in disease outcomes related to Clostridium difficile infection in patients with inflammatory bowel disease. Inflamm Bowel Dis 2011; 17: 976-83; http://dx.doi.org/10.1002/ibd.21457
  • Issa M, Vijayapal A, Graham MB, et al. Impact of Clostridium difficile on inflammatory bowel disease. Clin Gastroenterol Hepatol 2007; 5: 345-51; http://dx.doi.org/10.1016/j.cgh.2006.12.028
  • Issa M, Ananthakrishnan AN, Binion DG. Clostridium difficile and inflammatory bowel disease. Inflamm Bowel Dis 2008; 14: 1432-42; http://dx.doi.org/10.1002/ibd.20500
  • Kariv R, Navaneethan U, Venkatesh PG, et al. Impact of Clostridium difficile infection in patients with ulcerative colitis. J Crohns Colitis 2011; 5: 34-40; http://dx.doi.org/10.1016/j.crohns.2010.09.007
  • Mann SD, Pitt J, Springall RG, et al. Clostridium difficile infection--an unusual cause of refractory pouchitis: report of a case. Dis Colon Rectum 2003; 46: 267-70; http://dx.doi.org/10.1007/s10350-004-6533-1
  • Giuliano S, Guastalegname M, Jenco M, et al. Severe community onset healthcare-associated Clostridium difficile infection complicated by carbapenemase producing Klebsiella pneumoniae bloodstream infection. BMC Infect Dis 2014; 14: 475; http://dx.doi.org/10.1186/1471-2334-14-475
  • Guastalegname M, Russo A, Falcone M, et al. Candidemia subsequent to severe infection due to Clostridium difficile: is there a link? Clin Infect Dis 2013; 57: 772-4; http://dx.doi.org/10.1093/cid/cit362
  • Farina C, Arosio M, Mangia M, et al. Lactobacillus casei subsp. rhamnosus sepsis in a patient with ulcerative colitis. J Clin Gastroenterol 2001; 33: 251-2; http://dx.doi.org/10.1097/00004836-200109000-00019
  • Horton HA, Dezfoli S, Berel D, et al. Antibiotics for treatment of Clostridium difficile infection in hospitalized patients with inflammatory bowel diseases. Antimicrob Agents Chemother 2014; 58: 5054-9; http://dx.doi.org/10.1128/AAC.02606-13
  • Nitzan O, Elia M, Chazan B, et al. Clostridium difficile and inflammatory bowel diseases: role in pathogenesis and implications in treatment. W J Gastroenterol 2013; 19: 7577-85; http://dx.doi.org/10.3748/wjg.v19.i43.7577
  • Issa M, Weber LR, Skaros S, et al. Decreasing rates of colectomy despite high rates of hospitalization in Clostridium difficile infected IBD patients: a tertiary referral center experience. Gastroenterology 2007; 132: A663 (abstract)
  • Cornely OA. Current and emerging management options for Clostridium difficile infection: what is the role of fidaxomicin? Clin Microbiol Infect 2012; 18 Suppl 6: 28-35; http://dx.doi.org/10.1111/1469-0691.12012

Statistics

Abstract: 1351 views
HTML: 1058 views
PDF: 384 views

Refbacks

  • There are currently no refbacks.