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Published on: September 14, 2013
Clostridioides difficile infection after extracorporeal membrane oxygenation support for acute myocardial infarction:
Yanan Hu1,2, Chang Hu1,2, Jun Jiang1,2
1Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
Insights
Extracorporeal membrane oxygenation (ECMO) can cause Clostridioides difficile infection (CDI). This case highlights CDI development despite low-risk antibiotic use during ECMO, emphasizing the need for vigilance.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Extracorporeal membrane oxygenation (ECMO) is vital for cardiopulmonary support.
- Clostridioides difficile infection (CDI) is an uncommon complication associated with ECMO.
Observation:
- A 59-year-old male on ECMO for acute myocardial infarction developed severe diarrhea.
- Initial pulmonary infections were treated with low-dose piperacillin-tazobactam.
- Diagnosis of CDI was confirmed via toxin testing after ruling out other pathogens.
Findings:
- Vancomycin provided minimal improvement for CDI.
- Fecal microbiota transplantation (FMT) was highly effective in resolving CDI symptoms.
- The patient received short-term, low-dose antibiotics, considered low risk for CDI.
Implications:
- This case serves as a reference for recognizing uncommon CDI in ECMO patients.
- Highlights the potential for CDI even with low-risk antibiotic regimens.
- Suggests FMT as a potential effective treatment for refractory CDI in this population.
Introduction:
Restored cardiopulmonary function is efficiently achieved by utilizing extracorporeal membrane oxygenation (ECMO). Nevertheless, the incidence of Clostridioides difficile infection (CDI) associated with ECMO is relatively uncommon.
Case Presentation:
In this report, we present the case of a 59-year-old male with severe chest pain due to acute myocardial infarction, subsequently necessitating ECMO support. During the first day of hospitalization, pulmonary infections were observed, and piperacillin-tazobactam was prescribed for 7 days at low dosages. However, the patient developed severe diarrhea 4 days later. After ruling out common pathogens, we suspected the occurrence of CDI and performed genetic testing for C. difficile toxin, confirming our diagnosis. The prescription of vancomycin resulted in slight improvement, while fecal microbiota transplantation (FMT) proved to be more effective.
Conclusion:
In this case, temporary application of ECMO was applied, and the anti-infective treatment relied on the use of antibiotics at short-term, low-dose, and low CDI risk. Hence, the occurrence of CDI was considered an uncommon event, which may serve as a reference for future cases.
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