piperacillin--tazobactam-drug-combination and Enterocolitis--Pseudomembranous

Topics: Anti-Bacterial Agents; Cerebral Palsy; Clostridioides difficile; Enterocolitis, Pseudomembranous; Epilepsy, Tonic-Clonic; Fatal Outcome; Humans; Male; Metronidazole; Middle Aged; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Pneumonia, Aspiration; Radiography; Vancomycin

Antibiotic-induced diarrhea can be a significant source of morbidity. Pseudomembranous colitis, or Clostridium difficile-associated diarrhea (CDAD), is an increasingly reported adverse effect of therapy with broad-spectrum antibiotics and can prolong the hospital stay of affected patients. Although sharing some of the same clinical symptoms as CDAD, antibiotic-associated hemorrhagic colitis is a distinctly separate form of colitis that is characterized by the absence of toxin-producing C. difficile and the presence of hematochezia. Colonoscopy usually reveals extensive hemorrhage and inflammation in the lamina propria, with lack of pseudomembranes. Spontaneous resolution usually occurs shortly after cessation of the antibiotic. Infection with Klebsiella oxytoca, a gram-negative facultative aerobic enterobacterium, has been suggested as a possible cause for antibiotic-associated hemorrhagic colitis. Some K. oxytoca strains isolated from patients with antibiotic-associated hemorrhagic colitis produce a cytotoxin that can induce epithelial cell death and may predispose certain patients to hemorrhagic colitis during exposure to antibiotics. We describe a patient who developed hemorrhagic colitis shortly after starting a course of amoxicillin therapy for sinusitis prophylaxis. His stool samples were negative for C. difficile antigens but grew K. oxytoca. The patient received supportive care in conjunction with antibiotic coverage consisting of metronidazole and piperacillin-tazobactam. He improved throughout his hospital stay and was discharged on hospital day 11. Given the increasing concern for CDAD, clinicians should be careful not to overlook other possible causes for antibiotic-induced diarrhea.

Topics: Amoxicillin; Anti-Bacterial Agents; Anti-Infective Agents; Enterocolitis, Pseudomembranous; Humans; Klebsiella Infections; Klebsiella oxytoca; Male; Metronidazole; Middle Aged; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Sinusitis

States in 2002 on antimicrobial prescribing and associated rates of vancomycin-resistant enterococci (VRE) and Clostridium difficile infections.Design. Retrospective chart review.Setting. University-affiliated medical center. Measurements and Main Results. Microbiologic reports, patient demographics, and antimicrobial utilization were evaluated for patients admitted 6 months before the shortage (March 1-August 31, 2001) and for 6 months during the shortage (March 1-August 31, 2002). Significant increases in usage of alternative mu-lactamase inhibitor combinations, cefepime, levofloxacin, vancomycin, clindamycin, and metronidazole were observed during the shortage; in contrast, a significant decrease in the use of ceftriaxone took place. No change in the rate of VRE infection was observed from before to during the piperacillin-tazobactam shortage. However, a paradoxical 47% decrease in the rate of C. difficile colitis was documented during the shortage. Subsequent multivariate analyses suggested the reduced use of ceftriaxone and increased use of levofloxacin, but not the reduced use of piperacillin-tazobactam, correlated with the decreased rate of C. difficile infections.. The piperacillin-tazobactam shortage was associated with significant changes in antimicrobial prescribing, which resulted in a significant reduction in the rate of C. difficile but not VRE infections.

Topics: Anti-Bacterial Agents; California; Clostridioides difficile; Cross Infection; Drug Prescriptions; Drug Utilization; Enterococcus; Enterocolitis, Pseudomembranous; Gram-Positive Bacterial Infections; Humans; Length of Stay; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; United States; Vancomycin Resistance