INFECTIONS & INFLAMMATION: CLOSTRIDIUM DIFFICILE INFECTION
- Epidemiology
- Incidence is increasing with a preponderance of the NAP1 hypervirulent strain of C. difficile found in recent epidemics.
- The NAP1 strain is more likely to cause severe and fulminant colitis, characterized by marked leukocytosis, renal failure, hemodynamic instability, and toxic megacolon.
- It is believed the NAP1 strain arose due to the widespread use of fluoroquinolone antibiotics.
- Management
- Options:
- Oral vancomycin (more effective)
- Oral metronidazole
- Neither I.V. vancomycin nor I.V. metronidazole have been found to be more effective than the oral form of the medications for treatment of CDI.
- No role for fluoroquinolones.
- Metronidazole should be avoided in patients on warfarin
- Metronidazole interferes with warfarin metabolism
- Worsening diarrhea, fever, and leukocytosis despite appropriate antibiotics is an absolute indication for surgical consultation.
- Subtotal colectomy with end ileostomy is the procedure of choice for fulminant CD colitis nonresponsive to medications and has been documented to result in improved survival.
Answers
References
- Wein AJ, Kavoussi LR, Partin AW, Peters CA (eds): CAMPBELL-WALSH UROLOGY, ed 11. Philadelphia, Elsevier, 2015, vol 2, chap 12
