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Antimicrobial agents implicated in Clostridium difficile toxin-associated diarrhea of colitis
Abstract:
Records were reviewed for 329 patients who had antibiotic-associated diarrhea or colitis with stools showing a cytopathic toxin which is neutralized by Clostridium sordellii antitoxin. Previous studies indicate that the detection of this toxin implicate Clostridium difficile as the responsible pathogen. A spectrum of anatomical results in the colonic mucosa were found ranging from pseudomembranous colitis in 136 patients to an entirely normal endoscopic condition in 36 patients. The most frequently implicated agents were ampicillin, clindamycin, and cephalosporins. Collectively, these drugs accounted for approximately 80% of cases in which a single antimicrobial had been administered prior to the onset of symptoms. Analysis of data obtained in sequential time intervals showed a decline in the relative frequency of cases with use of clindamycin accompanied by an increase with use of cephalosporins. Less frequent drugs which were implicated in 3-8% of cases were, in rank order, penicillins other than ampicillin, erythromycin, sulfamethoxazole-trimethoprim and sulfasalazine. Tetracycline was the exclusive agent given to only three patients and there were no patients in whom chloramphenicol could be clearly implicated.
Insights
Antibiotic-associated diarrhea is often caused by Clostridium difficile, identified by its toxin. Ampicillin, clindamycin, and cephalosporins are the most common culprits, though their frequency varies over time.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Microbiology
Background:
- Antibiotic-associated diarrhea (AAD) and colitis are significant clinical concerns.
- The presence of a specific cytopathic toxin in stool, neutralized by Clostridium sordellii antitoxin, implicates Clostridium difficile as the causative agent.
- The spectrum of colonic mucosal findings in these patients ranges from pseudomembranous colitis to normal endoscopic appearance.
Purpose of the Study:
- To identify the antimicrobial agents most frequently associated with antibiotic-associated diarrhea and colitis caused by Clostridium difficile.
- To analyze trends in the causative agents over time.
Main Methods:
- Retrospective review of medical records for 329 patients diagnosed with antibiotic-associated diarrhea or colitis.
- Stool analysis to detect cytopathic toxin neutralized by Clostridium sordellii antitoxin.
- Correlation of implicated antimicrobial agents with patient diagnoses and endoscopic findings.
Main Results:
- Clindamycin, ampicillin, and cephalosporins were the most frequently implicated antimicrobials, accounting for approximately 80% of cases with single-agent exposure.
- A temporal trend was observed, with a decline in clindamycin-associated cases and an increase in cephalosporin-associated cases.
- Other implicated agents included other penicillins, erythromycin, sulfamethoxazole-trimethoprim, and sulfasalazine, each in 3-8% of cases.
- Tetracycline and chloramphenicol were rarely implicated.
Conclusions:
- Clindamycin, ampicillin, and cephalosporins are the primary drivers of Clostridium difficile-associated diarrhea and colitis.
- Shifting patterns in antimicrobial use correlate with changes in the relative frequency of implicated agents.
- Ongoing surveillance of antibiotic-associated gastrointestinal infections is crucial for understanding evolving etiological trends.