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pseudomembranous_colitis

pseudomembranous colitis

Introduction

  • a form of generally diffuse colitis resulting from antibiotic-induced overgrowth of Clostridium difficile (although other bacteria may also cause this picture such as Staph. aureus, Salmonella, etc) in the large bowel which results in a potentially life threatening colitis as a result of the production of two toxins which damage the mucosa and cause necrosis and inflammation
  • accounts for 20% of antibiotic-related diarrhoea
  • it was first described as a complication of C. difficile infection in 1978

Aetiology

  • usually occurs within 3-9 days of starting antibiotics but may occur much later, even weeks after ceasing antibiotics

Risk factors

  • any antibiotic can cause it, but especially broad spectrum beta lactams (penicillins, cephalosporins) or clindamycin
  • elderly
  • hospitalisation
  • presence of a virulent strain in the hospital
  • poor hand hygiene (spores are spread from faeces to surfaces to hands of healthcare workers)
  • inadequate cleaning of hospital rooms on discharge of patient
  • past GIT surgery
  • gastric acid suppression such as proton pump inhibitors (PPIs) or H2-type antihistamines
  • renal impairment
  • prolonged elemental diet (lacking in protein)

Clinical features

  • usually present with diarrhoea which is usually profuse, watery/mucoid and foul smelling (horse manure smell), and may contain blood or pseudomembranes
  • may then develop:

Diagnosis

  • suspect if new onset of more than three partially formed or watery stools per 24-hour period whilst on, or had recent antibiotics, especially if in hospital, and especially if develops abdominal pain and fever
  • urgent stool C.Diff PCR
    • may need repeating as not 100% sensitive

Mx

  • supportive care
  • IV rehydration may be required
  • contact precautions as per gastroenteritis
  • look for markers of severe disease:
    • T > 38.3 deg C
    • serum albumin < 25 g/L
    • peripheral WCC > 15,000 cells/microL
    • deteriorating renal function
    • elevated serum lactate
    • toxic megacolon
  • oral metronidazole tds
    • or oral qid vancomycin with cholestyramine (binds the two toxins) may be used in severe cases
  • +/- faecal / stool transplant
  • patients with severe disease will require iv antibiotic Rx and may require ICU care
pseudomembranous_colitis.txt · Last modified: 2018/08/11 14:13 (external edit)