Pseudomembranous Colitis

(C. Difficile Associated Diarrhoea)

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Features

- Most common Dx nosocomial diarrhoeal illness

-  Faecal colonization 20%/week of hospitalization

- Post Abx opportunistic infection of colon w Clostridium difficile

-  Multiplication & secretion of toxins

- Typically 5-10 days post Abx

-  Possible after 1 day or up to 10 weeks later

-  Possible no Abx exposure

-  Esp 3rd gen cephalosporins (Cefotaxime, Ceftriaxone)

 

Risk Factors

- Old age

- Colonisation

- Antacids

- GIT Sx

- Rectal thermometers

 

Associated S/S

- Cramping abdominal pain (22%)

- Diarrhoea

-  Profuse, mucoid, green, watery and malodorous

-  2-6 per day (up to 20)

- Fever (28%), nausea, malaise, anorexia

- Dehydration

- Adynamic ileus (20%)

-  May lead to Dx being overlooked

-  Toxic megacolon, sepsis --> perforation

 

Dx

- Diarrhoea + stool test +ve w toxin (as below) OR

- Pseudomembranes on colonoscopy + clinical suspicion

 

Ix

- Clostridium difficile toxin stool tests

-  Cytotoxic Assay

-  Toxin ELISA: quickest & cheapest

-  Stool Culture

- AXR: Adynamic ileus, toxic megacolon, DDx

- WBC: leukocytosis (50% pts)

- Colonoscopyy: pseudomembranes (50% pts)

 

Mx

- Cease offending Abx

- Hydration as required (IV, oral)

- Avoid antiperistaltic or opiates

- Metronidazole 500mg PO TDS or 250mg QID for 10/7

-  99% cure 2-4 days

-  Vancomycin if not tolerated or resistant

-  20% recurrence rate post Rx

- Toxic megacolon