cefoxitin and Enterocolitis--Pseudomembranous

We evaluated the isolation and quantitation of Clostridium difficile from aqueous and fecal samples utilizing ChromID CDIF and cycloserine, cefoxitin, and fructose-containing agar with horse blood and taurocholate media. Growth was similar between the two. ChromID CDIF provided enhanced isolation and required no ethanol pretreatment to inhibit normal flora. ChromID CDIF also improved turn-around time, requiring only 24 hours' incubation.

Topics: Bacteriological Techniques; Cefoxitin; Chromogenic Compounds; Clostridioides difficile; Culture Media; Cycloserine; Enterocolitis, Pseudomembranous; Feces; Fructose; Humans

The rapidly changing epidemiology of Clostridium difficile infection highlights the need for improved and continuing surveillance involving stool culturing to enable molecular tracking. Culture of C. difficile can be difficult and time consuming. In this report ChromID C. difficile agar (CDIF) was compared to cycloserine-cefoxitin-fructose-egg-yolk agar which contained 0.1% sodium taurocholate (TCCFA) as a germinant.. All ribotypes of C. difficile tested (n=90) grew well on CDIF within 24 h and most gave characteristic small irregular black colonies with a raised umbonate profile. Counts from standard suspensions of C. difficile at 24 h (p<0.005) and 48 h (p=0.01) were significantly higher on CDIF than on TCCFA. Similar results were achieved after alcohol shock. When temperature shock was used to differentiate vegetative cells and spores, the total number of culturable and vegetative cells on CDIF was significantly higher than on TCCFA (culturable cells, p=0.003 at 24 h and p=0.002 at 48 h; vegetative cells, p=0.0003 at 24 h and p=0.0002 at 48 h).. These data suggest that CDIF is a better medium for the recovery of vegetative C. difficile than TCCFA and equal to TCCFA for spore recovery.

Topics: Agar; Cefoxitin; Clostridioides difficile; Cycloserine; Enterocolitis, Pseudomembranous; Ethanol; Fructose; Humans; Microbiological Techniques; Ribotyping; Temperature; Time Factors

Topics: Aged; Antibiotic Prophylaxis; Cefoxitin; Cephamycins; Enterocolitis, Pseudomembranous; Humans; Hysterectomy, Vaginal; Male; Postoperative Complications

We reviewed hospital records of women on the obstetrics and gynecologic services with a diagnosis of antibiotic-associated diarrhea, pseudomembranous colitis, or Clostridium difficile infection to better characterize the incidence and course of women with C difficile infection. Cases were included if there was identification of C difficile by culture or toxin or endoscopic verification of pseudomembranous colitis. Between January 1985 and June 1995, there were 74,120 admissions to the obstetrics and gynecology services at two tertiary level hospitals. Eighteen women were found to have documented C difficile infection (0.02%)--3 from the obstetric services, 10 from the benign gynecologic services, and 5 from the gynecologic/oncology services. Diarrhea developed from 2 days to 30 days after antibiotics had been given (mean, 10 days). Nine patients had fever, six had nausea and vomiting, and five had abdominal pain. Antimicrobial agents given before infection included cephalexin, cefoxitin, imipenem, ciprofloxacin, trimethoprim/sulfamethoxazole, ampicillin, gentamicin, and clindamycin. All patients were treated successfully with inpatient antimicrobial agents-15 with metronidazole and 3 with vancomycin. There was one possible recurrence.

Topics: Abdominal Pain; Adult; Aged; Aged, 80 and over; Ampicillin; Anti-Bacterial Agents; Bacterial Toxins; Cefoxitin; Cephalexin; Cephalosporins; Cephamycins; Ciprofloxacin; Clindamycin; Clostridioides difficile; Colonoscopy; Diarrhea; Enterocolitis, Pseudomembranous; Female; Fever; Gentamicins; Humans; Imipenem; Incidence; Middle Aged; Nausea; Penicillins; Pregnancy; Pregnancy Complications, Infectious; Retrospective Studies; Thienamycins; Trimethoprim, Sulfamethoxazole Drug Combination; Vomiting

Clostridium difficile and/or toxin B were isolated from the faeces of 3 (1.6%) of 184 patients within the first two days of hospitalisation in the University of Tübingen, Gynaecological Clinic. With following stool samples from a total of 117 patients the isolation rate of C. difficile was examined in relation to the treatment with antibiotics. From the first group of 61 patients, who had had gynaecological operations and were not treated with any antibiotic, the isolation rate of C. difficile rose statistically but not significantly from 0% at the time of admission up to 3.3% during hospitalisation. Amongst the second group of 17 patients, who had had gynaecological operations and were treated with various antibiotics for at least three days, the isolation rate was also found to rise insignificantly from 0 to 11.8% (p < 0.1). The third group of 33 patients, who had had gynaecological operations and perioperative prophylaxis with cefoxitin (one to three doses 2 g each), the isolation rate rose significantly from 0 to 12.1% (p < 0.05). The result of this study shows that the bacterial flora of the gut was probably altered even after a very brief application of cefoxitin. In two environmental examinations on the wards of the patients of this study, C. difficile was not isolated in any case.

Topics: Adult; Aged; Anti-Bacterial Agents; Bacterial Proteins; Bacterial Toxins; Bacteriological Techniques; Cefoxitin; Clostridioides difficile; Cross Infection; Dose-Response Relationship, Drug; Drug Administration Schedule; Enterocolitis, Pseudomembranous; Feces; Female; Genital Diseases, Female; Humans; Middle Aged; Premedication; Surgical Wound Infection

Topics: Aged; Cefoxitin; Clindamycin; Enterocolitis, Pseudomembranous; Humans; Male; Middle Aged; Postoperative Care; Premedication; Prognosis

Topics: Cefoxitin; Enema; Enterocolitis, Pseudomembranous; Humans; Male; Middle Aged; Vancomycin

The case report is presented of a newborn that developed pseudomembranous colitis and intestinal obstruction after antibiotic therapy with cefoxitin and gentamicin in the first week of life. At laparotomy on the fifth day a complete obliteration of the descending colon by pseudomembranes was encountered. After resection of the diseased segment the recovery was uneventful. We believe this case is the first to be published of antibiotic-associated pseudomembranous colitis causing intestinal obstruction.

Topics: Cefoxitin; Colon; Drug Therapy, Combination; Enterocolitis, Pseudomembranous; Gentamicins; Humans; Infant, Newborn; Intestinal Obstruction; Male; Respiratory Distress Syndrome, Newborn

Clostridium difficile-associated diarrhea during prolonged therapy of obstetric and gynecologic infections is known to occur with use of all classes of antibiotics except vancomycin and the aminoglycosides. We present 11 cases of C. difficile-associated diarrhea which followed a short course of perioperative prophylaxis with cefoxitin during a 1-year period. Nine of the cases of C. difficile-associated diarrhea were among 162 women who received cefoxitin perioperative prophylaxis for cesarean section or hysterectomy, but none occurred in 85 women who received one of four other antibiotics for perioperative prophylaxis (p = 0.024, Fisher's exact test). The two other occurrences of C. difficile-associated diarrhea following perioperative prophylaxis with cefoxitin were in women who underwent exploratory laparotomy. We conclude that C. difficile-associated diarrhea is related to perioperative prophylaxis with cefoxitin.

Topics: Adolescent; Adult; Cefoxitin; Cesarean Section; Enterocolitis, Pseudomembranous; Female; Humans; Hysterectomy; Middle Aged; Premedication; Surgical Wound Infection

The authors investigated the kinetics, in serum and tissues, of clindamycin, metronidazole, cefoxitin and moxalactam given during colon surgery in the dog. Colon, rectus muscle and subcutaneous fat samples were taken at times of maximal contamination during the initial operation and at a second operation, 9 days after the first, when septic complications were most likely to occur in the healing tissues. Bioassay was used to measure the amount of active antibiotics in serum and tissues. Clindamycin achieved therapeutic levels in all tissues except those of the fresh wound, thus making it a better therapeutic than prophylactic agent. Metronidazole achieved therapeutic levels in both fresh and healing tissues. Cefoxitin and moxalactam did not achieve adequate levels in either fresh or healing tissues.

Topics: Animals; Anti-Bacterial Agents; Cefoxitin; Cephamycins; Clindamycin; Colon; Dogs; Enterocolitis, Pseudomembranous; Granulation Tissue; Metronidazole; Moxalactam; Premedication; Surgical Wound Infection; Tissue Distribution