Antibacterials
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Clostridioides difficile infection associated pseudomembranous colitis: 4 case reports A case series described four men, aged 25–73 years, who developed Clostridioides difficile infection associated pseudomembranous colitis during antibacterial treatment with cefepime, ceftriaxone, cefuroxime, ciprofloxacin, cotrimoxazole, meropenem, norfloxacin or tinidazole [dosages not stated;not all routes and durations of treatments to reactions onsets stated]. Case 1: The 67-year-old man, who had received empirical treatment with oral ciprofloxacin, oral cotrimoxazole [trimethoprimsulfamethoxazole] and oral tinidazole for presumed gastrointestinal and urinary tract infections in the previous 3 months, admitted with a 4 week history of abdominal pain, diarrhoea and fever. He was tachycardic and febrile. Laboratory investigations revealed WBC count of 36000 cells/mm3, haemoglobin of 8.9 g/dL, blood urea nitrogen level of 74.58 mg/dL and creatinine level of 4.8 mg/dL. Colonoscopy showed extensive mucosal oedema and erythema along with pseudomembranes in the rectum and sigmoid colon, which were suggestive of possible Clostridioides difficile infection associated pseudomembranous colitis. Colonic biopsy revealed chronic active colitis, which was suspected to be pseudomembranous colitis and real-time PCR of stool sample was positive for DNA of Clostridioides difficile. Clostridioides difficile infection associated pseudomembranous colitis was attributed to prior antibacterial use. He started receiving treatment with vancomycin and metronidazole along with supportive care. All other antibiotics were discontinued. A marked improvement with the resolution of fever and diarrhoea was noted, and he was discharged from hospital after 1 week. Case 2: The 70-year-old man, who had a history of type 2 diabetes mellitus, end-stage renal disease and hypertension, had received empirical treatment with oral cefuroxime and norfloxacin for 5 days for presumed urinary tract infections. He presented with a 3 week history of diarrhoea and fever. He had visited a local clinic due to diarrhoea. There he was treated with ceftriaxone for 5 days; however, his symptoms continued. He was hospitalised. His physical examination revealed tachycardia and lower abdominal tenderness. Laboratory investigations showed neutrophil predominant leucocytosis and stool microscopy revealed multiple polymorphonuclear cells with a few RBCs. Abdominal ultrasound revealed left-sided colonic wall thickening and sigmoidoscopy showed diffused mucosal erythema with multiple patchy exudates, which were suggestive of pseudomembranes. Colon biopsy revealed mucosal tissue fragments with explosive necro-inflammatory pseudomembranous exudate on the surface of ulcerated mucosal fragments. Variably dilated crypts partly filled with neutrophils and mucus, with superficial epithelial loss and uncertain expansion of lamina propria was also noted. A presumptive diagnosis of Clostridioides difficile infection associated pseudomembranous colitis was made. Clostridioides difficile infection
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