Enterocolitis caused by Clostridium difficile. Analysis of 15 cases in adults

Abstract

Each of 48 patients with suspected Clostridium difficile enterocolitis after treatment with antibiotics underwent a faecal test in which a Clostridium difficile culture was set up and a cytotoxin test carried out. The detection of Clostridium difficile was positive in 15 cases. Diarrhoea with varying severity was present in all patients, most frequently after medication with the newer cephalosporins. Nine patients also underwent rectoscopy: a typical pseudo-membranous colitis was seen only in 5 of these and a "non-specific" enterocolitis in only 4. Management in 12 patients involved discontinuance of the antibiotic followed by oral vancomycin therapy for an average of 7 days. A female patient suffered a recurrence but responded to a repeat application of vancomycin. The possibility of Clostridium difficile enterocolitis should always be kept in mind when diarrhoea with unclear aetiology occurs during antibiotic therapy. The cytotoxin test and culture identification of Clostridium difficile are suitable routine methods for confirming the diagnosis. In severe cases, treatment should commence without waiting for the microbiological results.