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Pseudomembranous Colitis - Medical Malpractice
Clostridium difficile is the major cause of pseudomembranous colitis, which is a colon infection that affects one out of every 200 patients admitted to the hospital. It can also happen in patients who are not hospitalized. The basic reason behind pseudomembranous colitis is being exposed to an antibiotic and then being infected with Clostridium difficile. The organism C. difficile accounts for around twenty five percent of hospital acquired antibiotic associated diarrhoea. In pseudomembranous colitis, there is the appearance of a membrane formed over the colon lining. It only occurs in about fifty percent of cases, however. It was discovered in the 1890s but it wasn't until the 1970s that all of the toxins of pseudomembranous colitis were discovered and the organism was completely identified.
The antibiotics that have triggered pseudomembranous colitis include quinolone antibiotics, clindamycin, macrolides, and cephalosporins. Proton pump inhibitors and antineoplastic drugs are non-antibiotic regimens that can lead to the disease as well.
Clostridium difficile is a spore-forming bacterium that can live on hospital surfaces for months. The risk of being colonized with Clostridium difficile so that nearly 20 percent of all hospitalized patients become colonized but have no symptoms. Children under the age of one year have a colonization rate of up to 60 percent. When these individuals take antibiotics, it alters the normal flora of the bowels, increasing the risk of C. difficile infections.
Infection with C. difficile is potentially life threatening. It has a death rate of slightly less than 2 percent. It costs an extra 3.6 hospital days of hospitalization and costs an average of $3700 extra dollars spent in treating the disease. At least 25 percent of affected individuals will get another attack sometime in the future.
Those at highest risk for pseudomembranous colitis are those who are over the age of 65. The mortality goes up with age as well. Infants and young children can also get colonized with the disease but only get an active infection in 4 out of 1000 hospital admissions.
Doctors diagnose pseudomembranous colitis by noting a past history of antibiotic use along with symptoms of diarrhoea and abdominal cramps that occur 5-10 days after starting the antibiotics. The type of antibiotics used and the length of use all play a role in getting the disease. A few patients will get pseudomembranous colitis without having an antibiotic exposure. Spores of C. difficile need to be ingested somehow-something that is not difficult to do in a hospital setting or in a nursing home setting. Spores can also be carried in the soil, on animals or pets. Contaminated food or household contacts may be related to getting C. difficile infection. Agents, such as enemas, stool softeners, opioids, and other bowel medications can make the situation worse. Patients who have ileus because of a bowel surgery are at increased risk and must be cared for with the idea that pseudomembranous colitis can be present. Proton pump inhibitors can make the problem worse. Impaired immunity due to immune diseases, cancer or HIV infections can play a role in getting pseudomembranous colitis.
Complications of pseudomembranous colitis include toxic megacolon, which can be fatal or perforation of the colon, which can lead to peritonitis. Most people just have mucoid, greenish and malodorous diarrheal and watery stools. There are usually 3-6 stools per day but some people have up to 20 stools per day. There is an increase in the white blood cell count in most patients who have the disease and up to 50 percent have a fever. Abdominal pain or cramping occurs in about a third of patients. Nausea, anorexia and malaise are also common.
The treatment of pseudomembranous colitis is to stop the offending agent, which results in resolution of symptoms in 2-3 days in 20 percent of cases. Others take longer than that to get better. Treatment should begin as soon as the diagnosis is suspected because of the complications you may get. Supportive care includes the use of fluid replacement and diarrheal support. You should avoid those things that shut off peristalsis because this can worsen the infection. Metronidazole or vancomycin can be used to kill off the Clostridium difficile. It can take up to 14 days of the antibiotic therapy to completely clear the bacterium from the system.LEGAL HELPLINE: ☎ 855 804 7125
The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here