Antibiotic-associated diarrhea and Clostridium difficile

2/17/2005

Question:  Are antibiotics an important risk factor for contracting Clostridium difficile diarrhea?

Ovid recovery search string (copy and paste into Ovid search entry panel)

-------------------------------------

16272491.ui or 15855751.ui or 15238493.ui or 15163654.ui or 12825250.ui or 12741099.ui or 12656693.ui or 12390059.ui or 12019070.ui or 11714055.ui or 11428874.ui or 10160466.ui or 8644759.ui or 7903557.ui or 6857419.ui or 509051.ui

-------------------------------------------------------

PubMed recovery search string (copy and paste into PubMed search entry panel)

-------------------------------------

16272491[PMID] OR 15855751[PMID] OR 15238493[PMID] OR 15163654[PMID] OR 12825250[PMID] OR 12741099[PMID] OR 12656693[PMID] OR 12390059[PMID] OR 12019070[PMID] OR 11714055[PMID] OR 11428874[PMID] OR 10160466[PMID] OR 8644759[PMID] OR 7903557[PMID] OR 6857419[PMID] OR 509051[PMID]

-------------------------------------------------------

<1>

Unique Identifier [PMID]: 16272491

Authors: De La Cochetiere MF. Durand T. Lepage P. Bourreille A. Galmiche JP. Dore J.

Institution: INSERM Unite 539 CHU Hotel-Dieu, Place Alexis Ricordeau, 44035 Nantes cedex 1, France. mfdlc@nantes.inserm.fr

Title: Resilience of the dominant human fecal microbiota upon short-course antibiotic challenge.

Source: Journal of Clinical Microbiology. 43(11):5588-92, 2005 Nov.

Abstract: Recent studies have shown that the human fecal microbiota is composed of a consortium of species specific to the host and resistant to modifications over time. Antibiotics are known to affect the intestinal microflora, and ensuing changes may result in antibiotic-associated diarrhea. It is therefore important to characterize the nature and amplitude of these modifications and the ability of this ecosystem to return to its original profile-i.e., its resilience. Six healthy volunteers received oral amoxicillin (1.5 g/day) for 5 days. Fecal samples were collected at day 0 (D0) before antibiotic treatment and at set intervals until 60 days thereafter. Fecal DNA was isolated, and V6-to-V8 regions of the 16S rRNA genes were amplified by PCR with general primers and analyzed by temporal temperature gradient gel electrophoresis. Dominant species profiles were compared on the basis of similarity (Pearson correlation coefficient). Dominant species profiles at D0 were used as a reference. The fecal microbiota showed a major shift in dominant species upon antibiotic treatment, starting 24 h after treatment initiation and reaching an average similarity of only 74% after 4 days. Within 30 days following antibiotic treatment, the fecal microbiota tended to reach an average similarity of 88% to the D0 value; within 60 days, the average similarity to the D0 value was 89%. However, in one subject, important modifications persisted for at least 2 months, with similarity to the D0 value remaining below 70%. We demonstrated the resilience of the dominant human fecal microbiota upon short-course antibiotic challenge. Yet the persistence of long-term alterations in some subjects may explain susceptibilities to antibiotic-associated diarrhea. Furthermore, these findings suggest that strategies reinforcing the ability of the fecal microbiota to resist modifications would be of clinical relevance.

Publication Type: Journal Article.

<2>

Unique Identifier [PMID]: 15855751

Authors: Surawicz CM.

Institution: Department of Medicine, University of Washington School of Medicine, Seattle, WA 98104, USA. surawicz@u.washington.edu

Title: Antibiotic-associated diarrhea and pseudomembranous colitis: are they less common with poorly absorbed antimicrobials?. [Review] [78 refs]

Source: Chemotherapy. 51 Suppl 1:81-9, 2005.

Abstract: Diarrhea is a well-known complication of antibiotic therapy. Rates of antibiotic-associated diarrhea (AAD) vary from 5 to 25%. Some antibiotics are more likely to cause diarrhea than others, specifically, those that are broad spectrum and those that target anaerobic flora. This paper reviews the effects of antibiotics on the fecal flora as well as host factors which contribute to AAD. Clinical features and treatment of AAD are also described. Prevention of AAD rests on wise antibiotic policies, the use of probiotics and prevention of acquisition in the hospital setting. Data from clinical trials suggest that poorly absorbed antimicrobials might have a decreased risk of causing AAD and Clostridium difficile-associated disease, as concluded from studies of antibiotics used for preoperative bowel decontamination and poorly absorbed antibiotics used for traveler's diarrhea. Controlled trials would prove this but are not yet available. Probiotics may be a good adjunct to poorly absorbed antibiotics to minimize the risk of diarrhea associated with antibiotics. Copyright (c) 2005 S. Karger AG, Basel. [References: 78]

Publication Type: Journal Article. Review.

<3>

Unique Identifier [PMID]: 15238493

Authors: Dial S. Alrasadi K. Manoukian C. Huang A. Menzies D.

Institution: Department of Critical Care, Montreal Chest Institute, QC. sandra.dial@mcgill.ca

Title: Risk of Clostridium difficile diarrhea among hospital inpatients prescribed proton pump inhibitors: cohort and case-control studies.[see comment].

Comments Comment in: CMAJ. 2004 Jul 6;171(1):45-6; PMID: 15238495, Comment in: CMAJ. 2004 Nov 23;171(11):1325-6; author reply 1326-7; PMID: 15557572

Source: CMAJ Canadian Medical Association Journal. 171(1):33-8, 2004 Jul 6.

Abstract: BACKGROUND: Antibiotic disruption of the normal intestinal flora is a well-known risk factor for Clostridium difficile-associated diarrhea. Reduced gastric acidity has been suggested as a risk factor, and we hypothesized that proton pump inhibitors, because of their potency, may be an independent risk factor for this problem. METHODS: For the cohort study we identified from a pharmacy database 1187 inpatients at a Montreal teaching hospital who received antibiotics over a 9-month period beginning in August 2002. We compared patients in this group who had also received a proton pump inhibitor or an H(2) blocker with patients who had not received acid suppressive therapy. Hospital laboratory reports of positive assay results for C. difficile toxin were used to ascertain cases in the cohort. To assess the possibility that proton pump inhibitors were prescribed to patients who were sicker and had other risk factors for C. difficile infection, we did a case-control study at a second Montreal teaching hospital. Cases were defined as patients who were positive for C. difficile toxin and who had a history of diarrhea (n = 94). Control subjects were selected from among patients who had received an antibiotic and were matched to cases by ward, age within 5 years and class of antibiotics (n = 94). RESULTS: In the cohort study, C. difficile diarrhea developed in 81 (6.8%) of the 1187 patients who received antibiotics while in hospital. In a multivariate analysis, C. difficile diarrhea was significantly associated with use of proton pump inhibitors (adjusted odds ratio [OR] 2.1, 95% confidence interval [CI] 1.2- 3.5), receipt of 3 or more antibiotics (OR 2.1, 95% CI 1.3- 3.4) and admission to a medical ward (OR 4.1, 95% CI 2.3- 7.3). In the case-control study C. difficile diarrhea was associated with female sex (adjusted OR 2.1, 95% CI 1.1-4.0), prior renal failure (adjusted OR 4.3, 95% CI 1.5-11.9), hospital admission in the 3 months before the index admission (adjusted OR 2.6, 95% CI 1.4-5.2) and use of proton pump inhibitors (adjusted OR 2.7, 95% CI 1.4-5.2). INTERPRETATION: Patients in hospital who received proton pump inhibitors were at increased risk of C. difficile diarrhea.

Publication Type: Journal Article. Multicenter Study.

<4>

Unique Identifier [PMID]: 15163654

Authors: Wilcox MH. Freeman J. Fawley W. MacKinlay S. Brown A. Donaldson K. Corrado O.

Institution: Departments of Microbiology and Elderly Medicine, Leeds Teaching Hospitals & University of Leeds, Old Medical School, Leeds LS1 3EX, UK. Mark.Wilcox@leedsth.nhs.uk

Title: Long-term surveillance of cefotaxime and piperacillin-tazobactam prescribing and incidence of Clostridium difficile diarrhoea.

Source: Journal of Antimicrobial Chemotherapy. 54(1):168-72, 2004 Jul.

Abstract: OBJECTIVES: We followed the effects of changes to a new antibiotic policy favouring a ureidopenicillin as opposed to a third-generation cephalosporin on the long-term incidence of Clostridium difficile diarrhoea (CDD) and antibiotic utilization in a large Elderly Medicine Unit. PATIENTS AND METHODS: In 1999, piperacillin-tazobactam was added to the formulary in Elderly Medicine and its use promoted in preference to cefotaxime. Following review and feedback to clinicians of surveillance data, cefotaxime prescribing was actively restricted during 2000-2001. An audit of prescriber adherence to antibiotic policy was carried out by reviewing the records of 159 patients during February-April 2001. In December 2001, due to manufacturer production problems, supply of piperacillin-tazobactam was stopped. We performed standardized period prevalence surveillance (February-April) allowing comparisons of antibiotic utilization and CDD incidence during the 5 year study period (1998-2002). RESULTS: CDD incidence did not change significantly (P>0.1) during 1998-1999 despite a marked increase in piperacillin-tazobactam prescribing. However, when cefotaxime prescribing was curtailed in 2001, CDD rates decreased (in four of five wards) and overall by 52% (P=0.008). When piperacillin-tazobactam became unavailable in 2002, despite advice to the contrary cefotaxime prescribing rose five-fold, and CDD rates increased in four of five wards and by 232% (P<0.01) overall. Adherence to antibiotic policy introduced in 2000 was good (81% accordance); 94%, 88% and 73% of patients with cellulitis, urinary tract and respiratory tract infection, respectively, received appropriate antibiotics. CONCLUSIONS: Long-term prescribing of piperacillin-tazobactam in Elderly Medicine in preference to cefotaxime is associated with reduced rates of CDD. However, unless cephalosporin prescribing is curtailed, the beneficial effects on CDD rates may be missed. This is one of few studies to document adverse effects due to loss of antibiotic supply.

Publication Type: Journal Article.

<5>

Unique Identifier [PMID]: 12825250

Authors: Jabbar A. Wright RA.

Institution: Division of Gastroenterology/Hepatology, Department of Medicine, University of Louisville, 530 South Jackson Street, Digestive Health Center, Louisville, KY 40292, USA.

Title: Gastroenteritis and antibiotic-associated diarrhea. [Review] [26 refs]

Source: Primary Care; Clinics in Office Practice. 30(1):63-80, vi, 2003 Mar.

Abstract: Acute gastroenteritis is a common cause of emergency and office visits. This article reviews causes, pathogenesis, diagnosis, prevention, and treatment. The incidence of antibiotic-associated colitis is increasing worldwide as a consequence of widespread use of broad-spectrum antibiotics for various illnesses. The pathogenic organism, Clostridium difficile, produces two enterotoxins, toxin A and toxin B, that cause colonic mucosal inflammation. C. difficile infection presents with a wide range of clinical manifestations, from asymptomatic carriers to life-threatening pseudomembranous colitis. [References: 26]

Publication Type: Journal Article. Review.

<6>

Unique Identifier [PMID]: 12741099

Authors: Lembcke B. Kist M. Lentze MJ. Bruns J. Gesche M. Herrmann M. Gyr N.

Institution: St. Barbara Hospital, Gladbeck.

Title: Antibiotic-associated diarrhea: incidence, risk factors of antibiotics and patients, pathophysiology and differential diagnosis--an interdisciplinary approach to a common problem. [Review] [25 refs]

Source: Schweizerische Rundschau fur Medizin Praxis. 92(16):751-9, 2003 Apr 16.

Abstract: Antibiotic-associated diarrhea (AAD) is a common complication of antibiotic treatment, most often seen in non-hospitalised patients. In principle, such diarrhea can be triggered by any antibiotic. An interdisciplinary working group discussed the different aspects of AAD in view of its gastroenterological, microbiological, paediatric, general medical and pharmaceutical implications, also in consideration of the position of patients and health insurance funds. The incidence, risk factors of antibiotics and patients, the pathophysiology of the various types of AAD and the differential diagnosis are reviewed. [References: 25]

Publication Type: Journal Article. Review.

<7>

Unique Identifier [PMID]: 12656693

Authors: Beaugerie L. Flahault A. Barbut F. Atlan P. Lalande V. Cousin P. Cadilhac M. Petit JC. Study Group.

Institution: Department of Gastroenterology, Saint-Antoine Medical Faculty, Universite Paris VI and Assistance Publique - Hopitaux de Paris, Paris, France. laurent.beaugerie@sat.ap-hop-paris.fr

Title: Antibiotic-associated diarrhoea and Clostridium difficile in the community.

Source: Alimentary Pharmacology & Therapeutics. 17(7):905-12, 2003 Apr 1.

Abstract: BACKGROUND: Clostridium difficile is the main cause of nosocomial infectious diarrhoea and the causative agent of antibiotic-associated colitis. The involvement of C. difficile infection in antibiotic-associated diarrhoea in the community is poorly documented. METHODS: We studied prospectively 266 adult out-patients in the Paris (France) area who were prescribed a 5-10-day course of antimicrobial chemotherapy. Stools were screened for C. difficile before and 14 days after the start of treatment by standard culture, toxigenic culture and testing for the cytopathic effect of toxin B. Patients were requested to note daily stool frequency and consistency. Diarrhoea was defined as the passage of at least three loose stools per day. RESULTS: Forty-six (17.5%) of the 262 assessable patients had diarrhoea during the study period. Diarrhoea was mild and self-limited in all patients, and lasted for only 1 day in 65.6% of cases. C. difficile was isolated before and after treatment from one patient, who did not develop diarrhoea. C. difficile was detected only on day 14 in 10 patients (3.8%). The isolate was toxin producing in seven patients. Four of these seven patients had mild self-limited diarrhoea. Toxin-producing C. difficile was isolated significantly more frequently from patients who had diarrhoea than from those who were diarrhoea free (8.7% vs. 1.4%, P = 0.02). CONCLUSION: The acquisition of toxin-producing C. difficile appears to be frequent during antimicrobial chemotherapy in the community [estimated rate of 2700 (1150-5400) cases per 100 000 exposures to antibiotics]. However, C. difficile is not the main agent of mild antibiotic-associated diarrhoea in out-patients.

Publication Type: Journal Article.

<8>

Unique Identifier [PMID]: 12390059

Authors: Hurley BW. Nguyen CC.

Institution: Division of Hospital Internal Medicine, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA.

Title: The spectrum of pseudomembranous enterocolitis and antibiotic-associated diarrhea. [Review] [32 refs]

Source: Archives of Internal Medicine. 162(19):2177-84, 2002 Oct 28.

Abstract: Pseudomembranous (entero)colitis is primarily caused by Clostridium difficile infection. The most common predisposing factor is prior use of antibiotics, including vancomycin and metronidazole, which themselves are therapy for C difficile colitis. Other risk factors have also been described. The presence of C difficile in the gastrointestinal tract leads to a spectrum of manifestations from the asymptomatic carrier state to fulminant colitis. Successful treatment of C difficile colitis requires prompt treatment with appropriate antibiotics, withdrawal of the suspected predisposing antibiotics, and, in rare cases, total colectomy. Preventive measures of adequate infection control and judicious use of antibiotics are necessary means in attempting to control the spread of C difficile infection. Attempts at making an effective human vaccine are currently under way. [References: 32]

Publication Type: Journal Article. Review.

<9>

Unique Identifier [PMID]: 12019070

Authors: Pelaez T. Alcala L. Alonso R. Rodriguez-Creixems M. Garcia-Lechuz JM. Bouza E.

Institution: Microbiology and Infectious Diseases Service, Hospital General Universitario Gregorio Maranon, Madrid, Spain.

Title: Reassessment of Clostridium difficile susceptibility to metronidazole and vancomycin.

Source: Antimicrobial Agents & Chemotherapy. 46(6):1647-50, 2002 Jun.

Abstract: Clostridium difficile is the most frequently identified enteric pathogen in patients with nosocomially acquired, antibiotic-associated diarrhea. The drugs most commonly used to treat diseases associated with C. difficile are metronidazole and vancomycin. Most clinical laboratories assume that all C. difficile isolates are susceptible to metronidazole and vancomycin. We report on the antimicrobial susceptibilities of 415 C. difficile isolates to metronidazole and vancomycin over an 8-year period (1993 to 2000). The overall rate of resistance to metronidazole at the critical breakpoint (16 microg/ml) was 6.3%. Although full resistance to vancomycin was not observed, the overall rate of intermediate resistance was 3.1%. One isolate had a combination of resistance to metronidazole and intermediate resistance to vancomycin. Rates of resistance to metronidazole and vancomycin were higher among isolates from human immunodeficiency virus-infected patients. Molecular typing methods proved the absence of clonality among the isolates with decreased susceptibilities to the antimicrobials tested.

Publication Type: Journal Article.

<10>

Unique Identifier [PMID]: 11714055

Authors: Abrahao C. Carman RJ. Hahn H. Liesenfeld O.

Institution: Department of Medical Microbiology and Immunology of Infection, Benjamin Franklin Medical Center, Free University of Berlin, Germany.

Title: Similar frequency of detection of Clostridium perfringens enterotoxin and Clostridium difficile toxins in patients with antibiotic-associated diarrhea.

Source: European Journal of Clinical Microbiology & Infectious Diseases. 20(9):676-7, 2001 Sep.

Publication Type: Journal Article.

<11>

Unique Identifier [PMID]: 11428874

Authors: Harbarth S. Samore MH. Carmeli Y.

Institution: Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA. harbarth@post.harvard.edu

Title: Antibiotic prophylaxis and the risk of Clostridium difficile-associated diarrhoea.

Source: Journal of Hospital Infection. 48(2):93-7, 2001 Jun.

Abstract: To test the hypothesis that extended antibiotic prophylaxis increases the risk of Clostridium difficile -associated diarrhoea (CDAD), we conducted a retrospective cohort study of 2641 patients under-going cardiovascular surgery. Main outcome measures were the duration of prophylaxis (< 48 h vs. > 48 h) and the occurrence of CDAD. CDAD occurred in 31 patients (1.2%), who were significantly older (70 +/- 9 y vs. 66 +/- 10 y; P = 0.03), received more therapeutic antibiotics (2.2 +/- 1.9 vs. 0.4 +/- 0.9; P = 0.001) and had a longer postoperative hospital stay (26 +/- 19 d vs. 9 +/- 8 d; P < 0.001) than non-cases. After adjusting for confounding, we did not observe an association between prolonged prophylaxis and CDAD [adjusted odds ratio (AOR), 0.8; CI, 0.4-1.8]. In contrast, three independent predictors were identified: increasing length of hospital stay (AOR per one-day-increment, 1.03; CI, 1.01-1.05), and treatment with third generation cephalosporins (AOR, 5.9; CI, 2.2-16.0) or beta-lactam-beta-lactamase inhibitor combinations (AOR, 4.6; CI, 1.7-12.3). Our results did not confirm that extended prophylaxis after clean surgery increases the risk of CDAD, which remains an uncommon postoperative complication, associated even with short antibiotic exposure. Copyright 2001 The Hospital Infection Society.

Publication Type: Journal Article.

<12>

Unique Identifier [PMID]: 10160466

Authors: Riley TV.

Institution: Department of Microbiology, University of Western Australia, Nedlands, Australia. triley@cyllene.uwa.edu.au

Title: Antibiotic-associated diarrhoea. A costly problem. [Review] [13 refs]

Source: Pharmacoeconomics. 10(1):1-3, 1996 Jul.

Publication Type: Journal Article. Review.

<13>

Unique Identifier [PMID]: 8644759

Authors: Katz DA. Lynch ME. Littenberg B.

Institution: Department of Medicine, White River Junction Veterans Administration Medical Center, Lebanon, New Hampshire, USA.

Title: Clinical prediction rules to optimize cytotoxin testing for Clostridium difficile in hospitalized patients with diarrhea.

Source: American Journal of Medicine. 100(5):487-95, 1996 May.

Abstract: BACKGROUND: Although routine testing of hospitalized patients with diarrhea for Clostridium difficile cytotoxin has been advocated as a high-yield procedure, the rationale for this practice has been questioned. To target a low-yield subgroup for whom routine testing could be deferred, we derived a clinical decision rule for predicting results of the C difficile cytotoxin assay in hospitalized adults with diarrhea. METHODS: We hypothesized a priori that two variables, antibiotic use (within 30 days prior to testing) and history of significant diarrhea (new onset of > 3 partially formed or watery stools per 24 hour period), would be highly predictive of cytotoxin results, and obtained these data on 480 consecutive patients who underwent diagnostic testing for C difficile at a university hospital and affiliated Veterans Affairs medical center. For more detailed modelling, we recorded symptoms, signs, comorbidity, and other potential causes of diarrhea for 68 test positive patients (cases) and 265 randomly selected test negative patients (controls) within the study cohort. RESULTS: The overall prevalence of positive cytotoxin assays was 14%. Prior antibiotic therapy (OR = 9.0, 95% CI 2.1-38.4), significant diarrhea (OR = 2.2, 95% CI 1.1-4.7), and abdominal pain (OR = 1.9, 95% CI 0.96-3.7) were independent predictors of cytotoxin assay results. The model discriminated patients with positive and negative assays with a receiver operating characteristic (ROC) area of 0.68; observed and predicted probabilities of a positive cytotoxin assay were well correlated over the entire range of observed probabilities (r2 = 0.86). A decision rule (defined as positive if prior antibiotic use and either significant diarrhea or abdominal pain are present) demonstrated sensitivity and specificity of 86 and 45%. When applied to the entire dataset (N = 480), a simplified a priori rule, defined as positive if both prior antibiotic use and history of significant diarrhea are present, demonstrated sensitivity, specificity, positive and negative predictive value of 80, 45, 18 and 94%, respectively (6% of those predicted to be cytotoxin-negative actually tested positive). Use of this rule would have averted 39% of cytotoxin assays in our study population. CONCLUSIONS: Patients without prior antibiotic use and either significant diarrhea or abdominal pain are unlikely to have positive C difficile cytotoxin assay results, and may not routinely require cytotoxin testing.

Publication Type: Journal Article.

<14>

Unique Identifier [PMID]: 7903557

Authors: Simor AE. Yake SL. Tsimidis K.

Institution: Baycrest Centre for Geriatric Care, Toronto, Ontario, Canada.

Title: Infection due to Clostridium difficile among elderly residents of a long-term-care facility.

Source: Clinical Infectious Diseases. 17(4):672-8, 1993 Oct.

Abstract: In a study of the epidemiology of infection due to Clostridium difficile at long-term-care facilities, we conducted point-prevalence surveys and obtained stool samples from residents receiving antibiotics and from those developing diarrhea during 1 year at a 350-bed nursing home and an adjoining 280-bed chronic-care hospital. C. difficile and/or its cytotoxin was detected in 236 specimens from 94 residents. Only 16 (17%) of these 94 individuals had diarrhea at the time C. difficile was detected. The prevalence of C. difficile infection ranged from 2.1% to 8.1% in the nursing home and from 7.1% to 14.7% in the hospital. The organism was recovered from six (8.8%) of 68 residents receiving antibiotics, and four of the six developed antibiotic-associated diarrhea. The receipt of antibiotic treatment within the previous 8 weeks (odds ratio [OR], 7.9), the presence of a nasogastric or gastrostomy feeding tube (OR, 6.5), urinary and fecal incontinence (OR, 2.5), and the presence of more than three underlying diseases (OR, 2.0) were statistically significant independent variables associated with C. difficile infection. Typing of isolates by restriction-endonuclease analysis indicated that most C. difficile infections at this long-term-care facility were associated with endogenous enteric carriage of the organism, with little evidence of cross-infection.

Publication Type: Journal Article.

<15>

Unique Identifier [PMID]: 6857419

Authors: Miller SD. Blake M. Miliotis M. Still C. Taubin A. Koornhof HJ.

Title: Antibiotic-associated diarrhoea and pseudomembranous colitis caused by Clostridium difficile. A review of 40 cases.

Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 63(24):936-9, 1983 Jun 11.

Abstract: We found antibiotic-associated diarrhoea (AAD) and pseudomembranous colitis caused by Clostridium difficile in 19% of patients with diarrhoea related to antibiotic therapy or with diarrhoea for which no other cause could be found. Ampicillin, cephalosporins and co-trimoxazole appear to be the agents most commonly associated with this complication. The clinical presentation of AAD falls into two categories: (i) an early-onset type characterized by severe diarrhoea with watery stools which may contain mucus; and (ii) a late-onset variety characterized by chronic, persistent diarrhoea with bulky stools. A definitive diagnosis was made in all cases by the detection of the cytotoxin of Cl. difficile in patients' stools using tissue culture assay. Discontinuation of the implicated agent when possible together with a 14-day course of oral vancomycin effected a cure in 90% of patients. The remaining 10% were successfully treated with a similar course of oral bacitracin.

Publication Type: Journal Article.

<16>

Unique Identifier [PMID]: 509051

Authors: Mogg GA. Keighley MR. Burdon DW. Alexander-Williams J. Youngs D. Johnson M. Bentley S. George RH.

Title: Antibiotic-associated colitis--a review of 66 cases.

Source: British Journal of Surgery. 66(10):738-42, 1979 Oct.

Abstract: We have reviewed 66 cases of antibiotic-associated colitis since March 1975, which have been associated with a 27 per cent mortality. We believe antibiotics may predispose patients to this condition which is caused by a toxin produced by Clostridium difficile. Although the disease is rare, it is more common than previously reported. The presentation, methods of diagnosis and treatment are discussed.

Publication Type: Journal Article.