Related Experiment Videos
How to identify the cause of antibiotic-associated diarrhea
1Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, USA.
Abstract:
Most cases of antibiotic-associated diarrhea are due to Clostridium difficile or are of enigmatic etiology. The antibiotics most often implicated are clindamycin, ampicillin or amoxicillin, and the cephalosporins. Clinical signs of antibiotic-associated diarrhea may be limited to watery stools; however, evidence of colitis (fever, cramps, leukocytosis, fecal leukocytes) suggests C. difficile infection. The tissue culture assay for C. difficile toxin remains the gold standard for diagnosis, but the enzyme immunoassay is a practical and reasonably accurate alternative. Anatomic changes, such as pseudomembranes, can be confirmed with endoscopy, but such evaluation is not required for diagnosis of C. difficile-associated pseudomembranous colitis.
Insights
Antibiotic-associated diarrhea often stems from Clostridium difficile infection. Diagnosis involves toxin assays, with enzyme immunoassay being a practical alternative to the gold standard tissue culture.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Pharmacology
Background:
- Antibiotic-associated diarrhea (AAD) is a common clinical issue.
- Clostridium difficile (C. diff) infection and idiopathic causes are primary etiologies.
- Clindamycin, ampicillin, amoxicillin, and cephalosporins are frequently implicated antibiotics.
Purpose of the Study:
- To review the etiology, clinical presentation, and diagnostic methods for antibiotic-associated diarrhea.
- To highlight the significance of Clostridium difficile in AAD.
- To discuss diagnostic approaches for C. diff infection.
Main Methods:
- Review of existing literature on antibiotic-associated diarrhea and C. diff.
- Analysis of clinical signs and symptoms associated with AAD.
- Evaluation of diagnostic techniques for C. diff toxin detection.
Main Results:
- Most AAD cases are caused by C. diff or have unknown causes.
- Clinical signs range from watery stools to colitis symptoms like fever and cramps.
- Tissue culture assay for C. diff toxin is the gold standard; enzyme immunoassay is a viable alternative.
Conclusions:
- C. diff is a major cause of antibiotic-associated diarrhea.
- Clinical presentation can indicate C. diff infection, prompting diagnostic testing.
- Accurate diagnosis of C. diff-associated pseudomembranous colitis can be achieved through toxin assays without mandatory endoscopy.