amoxicillin-potassium-clavulanate-combination and Enterocolitis--Pseudomembranous

Antibiotic-associated colitis is a gastrointestinal complication of antibiotic use commonly seen in hospitalised patients, with

Topics: Abdominal Pain; Aged; Amoxicillin-Potassium Clavulanate Combination; Diagnosis, Differential; Diarrhea; Enterocolitis, Pseudomembranous; Female; Gastrointestinal Hemorrhage; Humans; Klebsiella Infections; Klebsiella oxytoca; Tomography, X-Ray Computed

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Clostridioides difficile; Disease Susceptibility; DNA, Bacterial; DNA, Ribosomal; Enterocolitis, Pseudomembranous; Female; Humans; Intubation, Intratracheal; Pneumonia, Bacterial; Portugal; Ribotyping; RNA, Bacterial; Sequence Deletion; Spain; Vancomycin; Young Adult

Topics: Adult; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Infective Agents; Clostridioides difficile; Community-Acquired Infections; Cross Infection; Cross-Sectional Studies; Enterocolitis, Pseudomembranous; Fatal Outcome; Female; Humans; Male; Metronidazole

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; Ciprofloxacin; Clostridium; Enterocolitis, Pseudomembranous; Female; Humans; Immunocompetence; Metronidazole; Species Specificity; Ulcer

A series of infection control measures were introduced at the University Hospitals of Leicester NHS Trust in 2006-2007 to reduce the incidence of Clostridium difficile infection.. The aim of this study was to assess the impact of these measures on the incidence of C. difficile and to record the associated mortality in hip fracture patients.. A case matched comparison of mortality was conducted between C. difficile positive patients and C. difficile negative patients admitted with a hip fracture between 1st January 2003 and 30th September 2007. An interrupted time series analysis was performed to assess the effect of various infection control policies on the incidence of C. difficile infection.. The interrupted time series analysis showed that the only effective measure was changing antimicrobial prophylaxis to Co-amoxiclav in May 2007. This reduced the incidence of C. difficile from 7.1 to 1.5% (p<0.001). Six-month mortality in C. difficile positive patients was 71% 1 year before introduction of a diarrhoea treatment policy and 65% 1 year after (p=0.5) indicating treatment was ineffective. A matched cohort comparison over a 57-month period from January 2003 to September 2007 showed that the 6-month mortality was 67% in 170 C. difficile positive patients, 27% in 3247 C. difficile negative patients and 29% in the 170 C. difficile negative matched patients.. This 38% excess mortality indicated that C. difficile increased mortality and did not simply colonise the sickest patients. Changing prophylaxis to Co-amoxiclav was the most effective measure. This reduced the incidence of C. difficile by 80% and thus reduced mortality by prevention rather than cure.

Topics: Adult; Aged; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antibiotic Prophylaxis; Case-Control Studies; Cefuroxime; Clostridioides difficile; Cross Infection; Enterocolitis, Pseudomembranous; Hand Disinfection; Hip Fractures; Hospitalization; Humans; Incidence; Infection Control; Middle Aged; Practice Guidelines as Topic; Survival Rate; United Kingdom; Young Adult

The gastrointestinal tract is a complex ecosystem. Recent studies have shown that the human fecal microbiota is composed of a consortium of microorganism. It is known that antibiotic treatment alters the microbiota, facilitating the proliferation of opportunists that may occupy ecological niches previously unavailable to them. It is therefore important to characterize resident microbiota to evaluate its latent ability to permit the development of pathogens such as Clostridium difficile. Using samples from 260 subjects enrolled in a previously published clinical study on antibiotic-associated diarrhea, we investigated the possible relationship between the fecal dominant resident microbiota and the subsequent development of C. difficile. We used molecular profiling of bacterial 16S rDNA coupled with partial least square (PLS) regression analysis. Fecal samples were collected on day 0 (D0) before antibiotic treatment and on day 14 (D14) after the beginning of the treatment. Fecal DNA was isolated, and V6-to-V8 regions of the 16S rDNA were amplified by polymerase chain reaction with general primers and analyzed by temporal temperature gradient gel electrophoresis (TTGE). Main bacteria profiles were compared on the basis of similarity (Pearson correlation coefficient). The characteristics of the microbiota were determined using PLS discriminant analysis model. Eighty-seven TTGE profiles on D0 have been analyzed. The banding pattern was complex in all cases. The subsequent onset of C. difficile was not revealed by any clustering of TTGE profiles, but was explained up to 46% by the corresponding PLS model. Furthermore, 6 zones out of the 438 dispatched from the TTGE profiles by the software happened to be specific for the group of patients who acquired C. difficile. The first approach in the molecular phylogenetic analysis showed related sequences to uncultured clones. As for the 87 TTGE profiles on D14, no clustering could be found either, but the subsequent onset of C. difficile was explained up to 74.5% by the corresponding PLS model, thus corroborating the results found on D0. The non exhaustive data of the microbiota we found should be taken as the first step to assess the hypothesis of permissive microbiota. The PLS model was used successfully to predict C. difficile development. We found that important criteria in terms of main bacteria could be markedly considered as predisposing factors for C. difficile development. Yet, the resident microbiota in case

Topics: Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Base Sequence; beta-Lactams; Clostridioides difficile; Discriminant Analysis; DNA, Bacterial; Electrophoresis, Polyacrylamide Gel; Enterocolitis, Pseudomembranous; Feces; Female; Gastrointestinal Tract; Humans; Male; Middle Aged; Molecular Sequence Data; Polymerase Chain Reaction; Pristinamycin; RNA, Ribosomal, 16S

Antibiotic-associated hemorrhagic colitis is a distinct form of antibiotic-associated colitis in which Clostridium difficile is absent. Although the cause is not known, previous reports have suggested a role of Klebsiella oxytoca.. We studied 22 consecutive patients who had suspected antibiotic-associated colitis and who were negative for C. difficile. Patients underwent diagnostic colonoscopy, and among those who received a diagnosis of antibiotic-associated hemorrhagic colitis, stool samples were cultured for K. oxytoca. We isolated K. oxytoca strains and tested them for cytotoxin production using a tissue-culture assay. In addition, we also cultured stool samples obtained from 385 healthy subjects for K. oxytoca. An in vivo animal model for antibiotic-associated hemorrhagic colitis was established with the use of Sprague-Dawley rats.. Of the 22 patients, 6 had findings on colonoscopy that were consistent with the diagnosis of antibiotic-associated hemorrhagic colitis, and 5 of these 6 patients had positive cultures for K. oxytoca. No other common enteric pathogens were found in the five patients. Before the onset of colitis, all five were receiving penicillins, and two were also taking nonsteroidal antiinflammatory drugs (NSAIDs). All isolated K. oxytoca strains produced cytotoxin. K. oxytoca was found in 1.6% of the healthy subjects. In the animal model, K. oxytoca was found only in the colon of rats that received amoxicillin-clavulanate in addition to being inoculated with K. oxytoca. In these rats, infection with K. oxytoca induced a right-sided hemorrhagic colitis that was not observed in uninfected animals that received amoxicillin-clavulanate, indomethacin (an NSAID), or both.. Our fulfillment of Koch's postulates for cytotoxin-producing K. oxytoca suggests that it is the causative organism in at least some cases of antibiotic-associated hemorrhagic colitis. Infection with K. oxytoca should be considered in patients with antibiotic-associated colitis who are negative for C. difficile.

Topics: Adult; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Animals; Anti-Inflammatory Agents, Non-Steroidal; Bacterial Toxins; Cecum; Colon; Colonoscopy; Disease Models, Animal; Enterocolitis, Pseudomembranous; Feces; Female; Humans; Klebsiella Infections; Klebsiella oxytoca; Male; Middle Aged; Multivariate Analysis; Rats; Rats, Sprague-Dawley

The spore-forming anaerobic bacterium Clostridium difficile has become a serious enteropathogen. Oral and parenteral administration of antibiotics can cause ecological disturbances in the normal intestinal microflora. Suppression of the normal microflora may lead to reduced colonization resistance with subsequent overgrowth by pre-existing, naturally resistant microorganisms, such as C. difficile. C. difficile infection shows a range of clinical presentations between an asymptomatic carrier state, light diarrhea without inflammatory changes, and pseudomembranous colitis. C. difficile infection is acquired by the fecal-oral or environmental-oral routes. From March 2000 through March 2001 we assessed 48 cases of nosocomial antibiotic-associated diarrhea (AAD). Of these, 21 were due to C. difficile (CDAD). Cephalosporin was the agent most commonly associated with CDAD. Avoidance of cephalosporins, strict use of "single shot" prophylaxis, isolation of infected, symptomatic patients in single-bed rooms, improved hygiene and complete room disinfection lead to a rapid decrease of CDAD. The etiology, prognosis and prophylaxis are discussed in this paper.

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cefuroxime; Clostridioides difficile; Colectomy; Colonoscopy; Combined Modality Therapy; Diarrhea; Enterocolitis, Pseudomembranous; Fatal Outcome; Hematoma; Humans; Intestinal Mucosa; Male; Postoperative Complications; Staphylococcal Infections; Superinfection

Reactional joint disease subsequent to digestive tract infections have been well studied for Salmonella, Shigella, Yersinia and Campylobacter. Association with HLA B27 is well documented. A review of the literature since 1976 disclosed 23 cases of articular and extra-articular inflammatory reactions following pseudomembranous Clostridium difficile infection.. We describe 2 new cases which followed a favorable course. This is the usual outcome although inflammatory manifestations may persist or relapse.. The pathophysiological interest of this condition lies in the pathogenic potential of Clostridium difficile which appears to be directly related to toxin production. This would suggest an immune mechanism rather than pure infection.

Topics: Adult; Aged; Amikacin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Reactive; Clostridioides difficile; Diclofenac; Drug Therapy, Combination; Enterocolitis, Pseudomembranous; Feces; Female; Follow-Up Studies; Humans; Ketoprofen; Male; Metronidazole; Middle Aged; Recurrence; Time Factors