|
Snapshot
  • A 50-year-old female is hospitalized for a course of intravenous clindamycin to treat an abscess. Four days later she develops a watery diarrhea, with > 3 stools/day. Temperature is 102.2°F (39°C).  Physical exam reveals abdominal tenderness with no guarding. Her WBC was 15,000 mm³ and she had a positive fecal leucocyte test. Sigmoidoscopy reveals 0.2 - 2 cm raised adherent yellow plaques.

 

 

Introduction
  • Classification
    • bacteria
      • gram-positive bacilli
        • spore-forming
          • Clostridium
            • C. difficile
  • Pathogenesis
    • transmission
      • endogenous
    • predisposing factors
      • a hospitalized patient on antibiotics
    • reservoir
      • normal flora of colon
    • molecular biology
      • toxin A
        • enterotoxin damages intestinal mucosa leading to fluid increase
      • toxin B
        • cytotoxin that kills enterocytes
Presentation
  • Antibiotic-associated diarrhea 
    • clindamycin 
      • "Linda gives me diarrhea"
    • ampicillin
    • cephalosporins
    • amoxicillin
  • Colitis
  • Pseudomembranous colitis  
Evaluation
  • Diagnosis
    • toxin in stool
    • culture cannot be used to diagnose as organism is part of normal flora
  • Gram-positive, spore-forming rods 
  • Anaerobic
Differential
  • Infectious diarrhea: S. aureus, C. perfringens
  • Noninfectious diarrhea: Crohn's disease, irritable bowel syndrome
  • Acute abdomen: small bowel ileus, volvulus
Treatment
  • vancomycin or fidaxomicin
    • for initial episode of non-severe and severe C. difficile infection
      • preferred over metronidazole
      • 125 mg vancomycin orally 4 times per day or 200 mg fidaxomicin 2 times per day for 10 days
    • can be used for second recurrence of non-severe C. difficile infection
      • oral vancomycin in addition to intravenous metronidazole in patients who are
        • critically ill with fulminant or refractory disease
  • metronidazole  
    • indication
      • when vancomycin or fidamoxicin are not available
      • suggested only for non-severe infection
 

Please rate topic.

Average 3.4 of 7 Ratings

Questions (6)
EVIDENCE & REFERENCES (5)
Topic COMMENTS (4)
Private Note