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Clostridium difficile and cytotoxin in feces of patients with antimicrobial agent-associated pseudomembranous colitis

Clostridium difficile und sein Cytotoxin in den Faeces von Patienten mit Antibiotika-assoziierter pseudomembranöser Colitis

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Summary

Thirty patients with antimicrobial agent-associated pseudomembranous colitis (PMC) were studied for the presence ofClostridium difficile and its cytotoxin in feces. Either colonoscopy or barium enema radiography was required in three patients for the diagnosis of PMC because of nondiagnostic findings at sigmoidoscopy. Both the organism and cytotoxin were detected in 27 of the 30 patients;Staphylococcus aureus was excluded as the cause of PMC in two of the remaining patients. Eighteen of 19 patients withC. difficile-induced PMC who were treated with oral vancomycin had a salutary response; seven patients, however, had a relapse of colitis following the discontinuation of vancomycin. In general, relapses of colitis responded to retreatment with vancomycin. The implication ofC. difficile as a cause of diarrhea is best achieved by the demonstration of colonic mucosal plaques or of a pseudomembrane. The value of fecal culture forC. difficile and cytotoxin assay is limited by the existence of asymptomatic carriers.

Zusammenfassung

Bei 30 Patienten mit Antibiotika-assoziierter Colitis (PMC) wurde der Stuhl aufClostridium difficile und sein Cytotoxin untersucht. Bei drei Patienten waren Coloskopie oder Bariumeinlauf zur Absicherung der Diagnose einer PMC erforderlich, da der Befund der Sigmoidoskopie diagnostisch nicht weiterführte. Bei 27 der 30 Patienten waren Erreger und Cytotoxin nachweisbar; bei zwei der restlichen Patienten wurdeStaphylococcus aureus als Ursache für die PMC ausgeschlossen. 19 Patienten mitC. difficile-induzierter PMC wurden oral mit Vancomycin behandelt, 18 davon sprachen auf die Therapie an; doch trat nach Absetzen von Vancomycin bei sieben Patienten ein Colitis-Rezidiv auf. Diese Rezidive sprachen im allgemeinen auf eine nochmalige Vancomycinbehandlung an. Der Nachweis von Schleimhautplaques oder einer Pseudomembran ist der beste Nachweis für eine Beteiligung vonC. difficile. Der kulturelle Nachweis vonC. difficile in den Faeces und der Cytotoxin-Test sind wegen des Vorkommens von asymptomatischen Trägern in ihrem diagnostischen Wert eingeschränkt.

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Authors and Affiliations

  1. Wadsworth Medical Center, Wilshire & Sawtelle Boulevards, 90073, Los Angeles, CA, USA

    W. L. George M. D., V. A.

  2. Department of Microbiology, Texas Tech. University, 79430, Lubbock, TX, USA

    R. D. Rolfe Ph. D.

  3. Infectious Disease Section, St. Boniface Hospital, 409 Tache Avenue, St. Boniface, Manitoba, Canada

    G. K. M. Harding M. D. (Chief)

  4. 16100 Ventura Boulevard, 91436, Encino, CA, USA

    R. Klein M. D.

  5. Surgical Service, VA Medical Center, 85723, Tucson, AZ, USA

    C. W. Putnam M. D. (Chief)

  6. Infectious Disease Section (691/111F), V. A. Wadsworth Medical Center, Wilshire & Sawtelle Boulevards, 90073, Los Angeles, CA, USA

    S. M. Finegold M. D. (Chief)

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  1. W. L. George M. D., V. A.
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  2. R. D. Rolfe Ph. D.
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  5. C. W. Putnam M. D.
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  6. S. M. Finegold M. D.
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George, W.L., Rolfe, R.D., Harding, G.K.M. et al. Clostridium difficile and cytotoxin in feces of patients with antimicrobial agent-associated pseudomembranous colitis. Infection 10, 205–207 (1982). https://doi.org/10.1007/BF01666910

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  • DOI: https://doi.org/10.1007/BF01666910

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