Clostridium difficile 027-associated pseudomembranous colitis after short-term treatment with cefuroxime and cephalexin in an elderly orthopedic patient: a case report

Abstract

BackgroundClostridium difficile ribotype 027 has become increasingly prevalent in European countries. The clinical picture varies from self-limiting diarrhea to pseudomembranous colitis with toxic megacolon and ultimately death. Use of antibiotics is the principal risk factor; others include comorbidity, advanced age and hospitalization. However even with extensive knowledge of risk factors, it remains difficult to define “minimum risk,” as illustrated by the following case.Case presentationAn 80-year-old Danish man in good health was hospitalized for a penetrating knee injury. He received 5 days of intravenous cefuroxime after surgical revision and was discharged with oral cephalexin. Post-discharge he suffered from abdominal discomfort and was readmitted with ileus 4 days after discharge, i.e. 10 days after initiation of antibiotic treatment. His condition deteriorated, and pseudomembranous colitis was diagnosed. Due to lack of response to vancomycin and metronidazole, a total colectomy was performed. Stool cultures were positive for CD 027.ConclusionShort-term use of cephalosporins may have induced CD 027 infection, and the patient’s age was the only identifiable risk factor for the fulminant course. Thus, even short-term prophylactic treatment with cephalosporins cannot be considered entirely safe.

Antibiotics-associated pseudomembranous colitis: a disproportionality analysis of the US Food and Drug Administration Adverse Event Reporting System (FAERS) database

“…Currently, the main mechanism by which antibiotics cause PMC is that they suppress the growth of some normal micro-organisms, resulting in the increased colonization and proliferation of toxinogenic strains of C. di cile and the enhanced cytotoxin synthesis of C. di cile [18][19][20][21] . Moreover, production of antibiotics-resistance C. di cile is also an important risk factor for PMC [22][23][24] . Accumulating evidence suggests that C. di cile infection is the most common cause of PMC 1 .…”

Antibiotics-associated pseudomembranous colitis: a disproportionality analysis of the US food and drug administration adverse event reporting system (FAERS) database

“…Currently, the main mechanism by which antibiotics cause PMC is that they suppress the growth of some normal micro-organisms, resulting in the increased colonization and proliferation of toxinogenic strains of C. di cile and the enhanced cytotoxin synthesis of C. di cile [18][19][20][21] . Moreover, production of antibiotics-resistance C. di cile is also an important risk factor for PMC [22][23][24] . Accumulating evidence suggests that C. di cile infection is the most common cause of PMC 1 .…”

“…The distribution of age groups showed that the elderly are more susceptible to the antibiotics-associated PMC, especially for patients aged > 60 years. Currently, most studies on antibioticsassociated PMC are case reports, which lack of comprehensive analysis of age factor [24][25][26] . C. di cile is considered as the pathogenic microorganism in 90-100% of patients with antibiotics-associated PMC 27 .…”

Impact of a change in duration of prophylactic antibiotics on infectious complications after radical cystectomy with a neobladder

“…[24,25] The development of severe fulminant CDAD after short-term use of prophylactic cefuroxime in orthopedic patients was reported previously. [26] However, previous studies have suggested mixed results after CDAD and 2GC antimicrobial prophylaxis. [24,25,27] In the present study, the CDAD rate was similar between the short-term period and long-term period.…”