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Postoperative Clostridium difficile pseudomembranous colitis in idiopathic scoliosis. A brief clinical report
W R Osebold1, A N Cohen, M D Gillum
1St. Luke's Memorial Hospital, Spokane, Washington.
Insights
Two healthy young patients developed severe diarrhea after scoliosis surgery due to cephalosporin antibiotics, leading to Clostridium difficile colitis. This unexpected complication highlights antibiotic risks in pediatric spinal fusion patients.
Area of Science:
- Medicine
- Infectious Diseases
- Gastroenterology
Background:
- Idiopathic scoliosis is a common spinal deformity in adolescents.
- Surgical correction, like posterior fusion with instrumentation, is a standard treatment.
- Perioperative antibiotic prophylaxis is routinely used to prevent surgical site infections.
Observation:
- Two previously healthy young patients without prior gastrointestinal issues or allergies developed severe, explosive diarrhea postoperatively.
- The patients had undergone posterior fusion and Cotrel-Dubousset instrumentation for progressive idiopathic scoliosis.
- Diarrhea onset, severity, and presentation varied between the two cases, occurring sporadically over a 12-year period.
Findings:
- Postoperative diarrhea was confirmed as Clostridium difficile-associated pseudomembranous colitis via stool toxin assay.
- Initial symptoms were nonspecific, and diagnosis was delayed pending stool assay results.
- Recurrence of fever prompted renewed cephalosporin administration, potentially worsening the colitis.
Implications:
- This case series underscores the potential risk of Clostridium difficile colitis following spinal fusion surgery, even in young, healthy patients.
- The findings emphasize the need for heightened clinical suspicion for C. difficile infection in postoperative patients presenting with diarrhea, regardless of traditional risk factors.
- Careful antibiotic stewardship and early diagnostic consideration are crucial for timely management of this potentially severe complication.
Abstract:
The authors report two healthy young patients with progressive idiopathic scoliosis, both without allergies or histories of gastrointestinal disorders, who received perioperative preventive cephalosporin antibiotics, and developed explosive diarrhea postoperatively, confirmed as Clostridium difficile pseudomembranous colitis by stool toxin assay. Both patients had initially recovered uneventfully after posterior fusion and Cotrel-Dubousset instrumentation. Their youth, health, diagnosis, and lack of nosocomial factors made colitis unexpected. The two cases were sporadic, occurring 2 years apart over a 12-year observation period. Symptoms and signs of colitis for the two patients were markedly varied as to time of onset, order of appearance, and severity. Unexplained fever before onset of diarrhea led to renewed cephalosporin administration, potentially exacerbating the colitis. Initial symptoms and signs were nonspecific; appropriate treatment had to begin before diagnosis could be confirmed by stool toxin asay, which requires 2 days.