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Clostridium difficile and cytotoxin in feces of patients with antimicrobial agent-associated pseudomembranous colitis
Abstract:
Thirty patients with antimicrobial agent-associated pseudomembranous colitis (PMC) were studied for the presence of Clostridium difficile and its cytotoxin in feces. Either colonoscopy or barium enema radiography was required in three patients for the diagnosis of PMC because of nondiagnostic findings at sigmoidoscopy. Both the organism and cytotoxin were detected in 27 of the 30 patients; Staphylococcus aureus was excluded as the cause of PMC in two of the remaining patients. Eighteen of 19 patients with C. difficile-induced PMC who were treated with oral vancomycin had a salutary response; seven patients, however, had a relapse of colitis following the discontinuation of vancomycin. In general, relapses of colitis responded to retreatment with vancomycin. The implication of C. difficile as a cause of diarrhea is best achieved by the demonstration of colonic mucosal plaques or of a pseudomembrane. The value of fecal culture for C. difficile and cytotoxin assay is limited by the existence of asymptomatic carriers.
Insights
Clostridium difficile (C. diff) and its toxin cause most cases of pseudomembranous colitis (PMC). Oral vancomycin effectively treats PMC, though relapses can occur and typically respond to retreatment.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Microbiology
Background:
- Antimicrobial agents can precipitate pseudomembranous colitis (PMC), a severe gastrointestinal condition.
- Clostridium difficile (C. diff) is a suspected causative agent in PMC, often associated with antibiotic use.
Purpose of the Study:
- To investigate the prevalence of Clostridium difficile and its cytotoxin in patients diagnosed with antimicrobial agent-associated PMC.
- To evaluate the efficacy of oral vancomycin in treating C. diff-induced PMC and assess relapse rates.
Main Methods:
- Fecal samples from 30 patients with PMC were analyzed for the presence of C. difficile and its cytotoxin.
- Diagnostic confirmation of PMC involved sigmoidoscopy, colonoscopy, or barium enema radiography.
- Treatment efficacy was assessed in 19 patients with C. diff-induced PMC receiving oral vancomycin.
Main Results:
- C. difficile and its cytotoxin were detected in 27 out of 30 patients with PMC.
- Staphylococcus aureus was ruled out as a cause in two cases.
- 18 of 19 patients treated with oral vancomycin showed improvement, but 7 experienced relapses, which responded to retreatment.
Conclusions:
- Clostridium difficile is the primary causative agent of pseudomembranous colitis.
- Oral vancomycin is an effective treatment for C. diff-induced PMC, with relapses generally manageable through retreatment.
- Diagnosis of C. diff-associated diarrhea is best confirmed by identifying colonic pseudomembranes; fecal tests are limited by asymptomatic carriers.