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Clostridioides difficile Infection following Procalcitonin-guided Antibiotic Therapy for COVID-19
Anton G Elepaño1, Jonnel B Poblete1, A Nico Nahar I Pajes1
1Philippine General Hospital, University of the Philippines Manila.
Insights
Routine antibiotic use during COVID-19 may increase Clostridioides difficile infection risk, particularly in chronic kidney disease (CKD) patients. Procalcitonin interpretation also poses challenges in these cases.
Area of Science:
- Infectious Diseases
- Nephrology
- Critical Care Medicine
Background:
- A 50-year-old male with chronic kidney disease (CKD) presented with acute diarrhea and fever.
- The patient had a recent hospitalization for COVID-19, treated with antibiotics for pneumonia.
- Elevated procalcitonin levels were noted during the prior COVID-19 admission.
Observation:
- The patient developed acute diarrhea and fever during recovery from COVID-19.
- Diagnostic workup revealed a positive stool test for Clostridioides difficile (C. diff) antigen and toxin.
- The patient's clinical presentation suggested a severe C. diff infection.
Findings:
- The patient was diagnosed with fulminant Clostridioides difficile infection.
- Treatment with oral vancomycin and intravenous metronidazole led to symptom resolution.
- This case highlights a potential complication of antibiotic therapy in the context of COVID-19.
Implications:
- Routine antibiotic administration during viral pandemics warrants careful consideration due to potential secondary infections like C. diff.
- Procalcitonin interpretation in COVID-19 patients, especially those with CKD, requires caution due to potential confounding factors.
- This case underscores the importance of vigilant diagnosis and management of C. diff infections in vulnerable patient populations.
Abstract:
We present a case of a 50-year-old man with chronic kidney disease (CKD) presenting with acute diarrhea and fever. He was admitted a month prior for COVID-19, where he received antibiotics for radiographic findings of pneumonia and elevated procalcitonin. In the emergency department, his stool sample tested positive for Clostridioides difficile antigen and toxin. He was given oral vancomycin and intravenous metronidazole for fulminant C. difficile infection and was discharged with resolution of symptoms. This case documents a potential risk associated with routine antibiotic use during the pandemic and the pitfalls in interpreting procalcitonin, especially in patients with COVID-19 and CKD.
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