Infections: Clostridium Difficile Infection
Epidemiology edit
- 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 edit
- 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.
Questions edit
Answers edit
References edit
- Wein AJ, Kavoussi LR, Partin AW, Peters CA (eds): CAMPBELL-WALSH UROLOGY, ed 11. Philadelphia, Elsevier, 2015, vol 2, chap 12