Abstract
Although colitis is often seen in critically ill patients who have received multiple broad-spectrum antibiotics, there are no reports describing severe sepsis as a result ofClostridium difficile infection. We describe three cases of severe sepsis with local intestinalClostridium difficile infection as the only identifiable etiology. The mechanism of severe sepsis may be a derangement of the gastrointestinal barrier function. This could result in absorption of microbes or endotoxin or activation of inflammatory cascades in the submucosa of the intestine or liver.
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Parrilo JE, Parker MM, Natanson C (1990) Septic shock: advances in the understanding of pathogenesis, cardiovascular dysfunction, and therapy. Ann Intern Med 113:227–242
Niederman MS, ein AM (1990) Sepsis syndrome, the adult respiratory distress syndrome, and nosocomial pneumonia: a common clinical sequence. Clin Chest Med 11:663–665
Increase in national hospital discharge survey rates for septicemia: United States, 1979–1987 (1990), MMWR 39:31–34
Kelly CP, Pothoulakis C, LaMont JT (1994) Clostridium difficile colitis. N Engl J Med 330(4):257–262
Tedesco FJ, Barton RW, Alpers DH (1974) Clindamycin-associated colitis: a prospective study. Ann Intern Med 81:429–433
Nolan NPM, Kelly CP, Humphreys JFH (1987) An epidemic of pseudomembranous colitis: importance of person-to-person spread. Gut 28:1467–1473
ACCP/SCCM Consensus Conference. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis (1992). Chest 101: 1644–1655
Bone RC (1991) Sepsis syndrome: new insights into its pathogenesis and treatment. Infect Dis Clin North Am (1979) 5:793–805
Mogg GM, Keighly M, Burton DW (1989) Antibiotic-associated colitis: A review of 66 cases. Br Surg J 66:738
Wilmore DW, Smith RJ, D'Dwyer ST (1988) The gut: a central organ after surgical stress. Surg St Louis 104: 917–923
Deitch EA (1990) The role of intestinal barrier failure and bacterial translocation in the development of systemic infection and multiple organ failure. Arch Surg 125:403–404
Fink MP (1994) Effect of critical illness on microbial translocation and gastrointestinal mucosa permeability. Semin Respir Infect 9(4):256–260
Fekety R (1990) Antibiotic-associated colitis. In: Mandell GL, Douglas RG Jr, Bennet JE (eds) Principles and Practice of Infectious Diseases, 3rd edition. Churchill Livingstone, New York, pp 863–869
Caputo GM, Weitekamp MR, Bacon AE, Whitener C (1994)Clostridium difficile infection: a common clinical problem for the general internist. J Gen Intern Med 9:528–533
Jacobs NF (1994) Antibiotic-induced diarrhea and pseudomembranous colitis. Postgrad Med 95(8):111–120
Dixon CF, Weismann RE (1948) Acute pseudomembranous enteritis or enterocolitis: a complication following intestinal surgery. Surg Clin North Am 28: 999–1023
Waddell TK, McLeod RS, Rotstein OD, Cohen Z (1992) Surgical management of fulminant pseudomembranous colitis. Can J Surg (1980) 35(5):555–559
Davidson ED, Mahmoud J, Hersh T, Barnett SM (1980) Antibiotic-associated colitis: a persisent clinical problem. South Med J 73(4):444–447
Kappas A, Shinagawa N, Araby Y (1978) Diagnosis of pseudomembranous colitis. BMJ 1:675–678
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Lowenkron, S.E., Waxner, J., Khullar, P. et al. Clostridium difficile infection as a cause of severe sepsis. Intensive Care Med 22, 990–994 (1996). https://doi.org/10.1007/BF02044130
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DOI: https://doi.org/10.1007/BF02044130