cefotaxime and Enterocolitis--Pseudomembranous

Clostridium difficile diarrhoea is an increasingly important nosocomial infection. Clostridium difficile infection is associated with antibiotic use. The elderly are at greatest risk. We reported an outbreak associated with the use of cefotaxime, a third-generation cephalosporin. We review the extent of this association, putative causal mechanisms and suggest an integrated approach to the control of C difficile infection which focuses on both limiting environmental contamination and reducing patient susceptibility. Future developments are also considered, especially the potential for vaccination.

Topics: Aged; Cefotaxime; Cephalosporins; Clostridioides difficile; Cross Infection; Diarrhea; Enterocolitis, Pseudomembranous; Forecasting; Humans; Risk Factors

Rates of Clostridium difficile diarrhoea have recently been rising, with the elderly being at highest risk.. To compare the incidence of C. difficile colonization and diarrhoea in elderly patients treated for presumed infection with either empirical cefotaxime (CTX) or piperacillin-tazobactam (PT).. A prospective, ward-based, crossover study was carried out on two well-matched care of the elderly wards at a UK tertiary care hospital, in patients requiring empirical broad-spectrum antibiotic treatment.. There was a highly significant increased incidence of C. difficile colonization (26/34 vs. 3/14, P=0.001) and diarrhoea (18/34 vs. 1/14, P=0.006) in patients who received CTX as opposed to PT. DNA fingerprinting suggested that most infections arose from strains acquired from the hospital environment.. Elderly patients are significantly less likely to develop C. difficile diarrhoea after treatment with PT than after CTX. The source of C. difficile appears to be predominantly from the ward environment.

Topics: Aged; beta-Lactamase Inhibitors; Cefotaxime; Clostridioides difficile; Cross Infection; Cross-Over Studies; Diarrhea; Drug Combinations; Enterocolitis, Pseudomembranous; Enzyme Inhibitors; Female; Humans; Male; Opportunistic Infections; Penicillanic Acid; Piperacillin; Prospective Studies; Tazobactam

Topics: Anti-Infective Agents; Breast Feeding; Cefotaxime; Drug Therapy, Combination; Enterocolitis, Pseudomembranous; Gentamicins; Humans; Immunoglobulin gamma-Chains; Infant, Newborn; Laparotomy; Metronidazole; Parenteral Nutrition; Probiotics; Risk Factors

Immunoglobulin A (IgA) nephropathy, the most common cause of glomerulonephritis worldwide, is usually idiopathic in origin and renal limited. Secondary IgA nephropathy has been associated with systemic disease, including such gastrointestinal tract disturbances as celiac sprue and inflammatory bowel disease. We describe gross hematuria and reversible acute renal failure from IgA nephropathy in a patient with cephalosporin-induced Clostridium difficile colitis. In addition to mesangial IgA and C3 deposition, renal histological examination showed glomerular bleeding, intratubular red blood cell casts, and acute tubular necrosis. To the best of our knowledge, this is the first report of an association between IgA nephropathy and C difficile colitis.

Topics: Acute Kidney Injury; Adult; Cefixime; Cefotaxime; Cephalosporins; Clostridioides difficile; Enterocolitis, Pseudomembranous; Female; Glomerulonephritis, IGA; Humans; Kidney

Topics: Aged; Arthritis; Arthritis, Reactive; Cefixime; Cefotaxime; Cephalosporins; Clostridioides difficile; Diagnosis, Differential; Diarrhea; Enterocolitis, Pseudomembranous; Humans; Male

Topics: Antibiotic Prophylaxis; Cefotaxime; Cephalosporins; Clostridioides difficile; Enterocolitis, Pseudomembranous; Humans

Topics: Cefotaxime; Cephalosporins; Diarrhea; Enterocolitis, Pseudomembranous; Humans

Topics: Aged; Cefotaxime; Cephalosporins; Diarrhea; Enterocolitis, Pseudomembranous; Female; Humans; Male

Topics: Aged; Aged, 80 and over; Cefotaxime; Diarrhea; Enterocolitis, Pseudomembranous; Female; Humans; Male; Risk Factors

Clostridium difficile causes a broad spectrum of enteric diseases in humans, ranging from mild antibiotic-associated diarrhoea to more severe pseudomembranous colitis. The authors report four cases of life-threatening pseudomembranous colitis with haemodynamic changes. Infection due to Clostridium difficile should be kept in mind whenever a patient undergoing antibiotic therapy develops a symptomatology of an acute abdomen.

Topics: Abdomen, Acute; Adult; Aged; Anti-Bacterial Agents; Cefotaxime; Clostridioides difficile; Diagnosis, Differential; Enterocolitis, Pseudomembranous; Fatal Outcome; Female; Humans; Male; Middle Aged

Topics: Cefixime; Cefotaxime; Child; Child, Preschool; Enterocolitis, Pseudomembranous; Female; Humans; Male; Vancomycin

Clostridium difficile plays an essential role in causing pseudomembranous colitis. We looked for the presence of these bacteria in the stools of 169 hospitalized patients and 38 nurses from wards with cases of diarrhea (207 subjects). The study was divided into three parts. In the first part, we compared three methods for isolating Clostridium difficile from stool samples: pre-selection with heat-shock, direct plating on Cycloserine-Cefotaxime-Fructose Agar (CCFA) and culturing in a selective broth medium. Final identification of Clostridium difficile was achieved by gas-chromatography and ApiZym. From the 207 consecutively obtained stool specimens, Clostridium difficile was isolated in 108 (52%) when pre-treated by heat-shock compared to only 26 (13%) when plated on modified CCFA and 23 (11%) when cultured in selective broth medium. Pre-selection significantly increases the isolation rate for Clostridium difficile and should be used in further epidemiological research. In the second part of our study, a retrospective review of subjects' records showed that the heat-shock method detected Clostridium difficile in all age groups at a higher rate than the other methods. In the third part of our study, we typed the 157 isolates of Clostridium difficile strains by protein patterns using SDS-PAGE, and 16 distinct groups were identified. In 19 cases different Clostridium difficile strains were found in the same subject by SDS-PAGE. Finally, the isolated strains were compared with strains from Brussels and Freiburg. Matching patterns were noted in only three cases.

Topics: Adolescent; Adult; Agar; Age Factors; Anti-Bacterial Agents; Cefotaxime; Child; Child, Preschool; Chromatography, Gas; Clostridioides difficile; Culture Media; Cycloserine; Diagnosis, Differential; Electrophoresis, Polyacrylamide Gel; Enterocolitis, Pseudomembranous; Feces; Female; Fructose; Hot Temperature; Humans; Infant; Infant, Newborn; Male; Molecular Weight; Retrospective Studies; Risk Factors; Sensitivity and Specificity; Serotyping

Treatment of neonatal necrotizing enterocolitis (NEC) regularly includes broad-spectrum antibiotics but there has been no comparative study of alternative regimens. We have studied 90 infants with definite NEC; 46 cases in 1982-3 were treated with ampicillin and gentamicin, while 44 cases in 1984-5 received cefotaxime and vancomycin. Groups were well matched and managed uniformly. Infants greater than or equal to 2200 g birthweight did well with either regimen. Smaller infants given cefotaxime and vancomycin had a lower risk of culture-positive peritonitis (P = 0.01), and as a result, were less likely to die (P = 0.048) or develop thrombocytopenia (P = 0.004). The better outcome might be explained by the greater suppression by cefotaxime and vancomycin of the gut flora of treated patients (P less than 0.001). Both regimens were well-tolerated. Our data suggest that carefully chosen antibiotic regimens can improve the outcome of NEC.

Topics: Ampicillin; Anti-Bacterial Agents; Birth Weight; Cefotaxime; Clinical Protocols; Drug Therapy, Combination; Enterocolitis, Pseudomembranous; Feces; Gentamicins; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Newborn, Diseases; Vancomycin

Topics: Cefotaxime; Clostridium Infections; Disease Outbreaks; Enterocolitis, Pseudomembranous; Humans; Ireland; Male

Topics: Cefotaxime; Cholestyramine Resin; Clindamycin; Drug Therapy, Combination; Enterocolitis, Pseudomembranous; Humans; Uremia; Vancomycin

Topics: Adult; Aged; Cefotaxime; Clostridium Infections; Enterocolitis, Pseudomembranous; Female; Humans; Male; Middle Aged

Topics: Aged; Cefotaxime; Enterocolitis, Pseudomembranous; Humans; Male

Topics: Adult; Cefotaxime; Colon; Colonoscopy; Drug Therapy, Combination; Enterocolitis, Pseudomembranous; Female; Gentamicins; Humans; Hysterectomy; Methylmethacrylates; Metronidazole; Obstetric Labor Complications; Pregnancy; Puerperal Disorders; Shock; Uterine Hemorrhage; Vancomycin

Topics: Aged; Cefotaxime; Enterocolitis, Pseudomembranous; Humans; Male

Adverse reactions to various antibacterial drugs were compared in a review of the following: multiple-dose studies of cefotaxime (n = 3,463), cefazolin (n = 554), the combination gentamicin-clindamycin (n = 163), and cefoxitin (n = 18); prophylactic studies of cefotaxime (n = 300) and cefazolin (n = 149); and single-dose studies of cefotaxime (n = 314) and penicillin G procaine (n - 265). The demographic and background characteristics of the groups were similar. Results of extensive pretreatment and posttreatment laboratory tests, measures of vital signs, and physical examinations revealed no clinically important intergroup differences. In the multiple-dose studies, side effects were reported in 9.8% of the cefotaxime, 3.8% of the cefazolin, 17.2% of the gentamicin-clindamycin, and 16.7% of the cefoxitin patients. The most frequent side effects were reactions at the injection site, of the skin and appendages, and of the digestive and urogenital systems, the only significant difference being fewer injection-site reactions in the cefazolin group than in the other three groups. In the prophylactic studies one cefotaxime patient reported rash and pruritus. In the single-dose studies, side effects were reported in 1.6% of the cefotaxime and 4.2% of the penicillin patients. Side effects sufficiently severe to warrant drug discontinuation were reported in 2.1% of the cefotaxime, 0.7% of the cefazolin, 1.8% of the gentamicin-clindamycin, and in none of the cefoxitin patients. Posttreatment prolongation of prothrombin time was found in one cefotaxime patient, whose pretreatment value was also abnormal, and in two gentamicin-clindamycin patients. No patient deaths were attributed to any of the drugs.

Topics: Blood Pressure; Cefotaxime; Clinical Laboratory Techniques; Disulfiram; Enterocolitis, Pseudomembranous; Humans; Injections, Intramuscular; Pain; Prothrombin Time