scholarly journals Toxic Megacolon: Background, Pathophysiology, Management Challenges and Solutions [Corrigendum]

2021 ◽  
Vol Volume 14 ◽  
pp. 309-310
Author(s):  
Jiten Desai ◽  
Mohamed Elnaggar ◽  
Ahmed A Hanfy ◽  
Rajkumar Doshi
Keyword(s):  
Toxic Megacolon

Self-Administered Home Series Fecal “Minitransplants” for Recurrent Clostridium difficile Infection on a Rectal Remnant

2015 ◽  
Vol 24 (4) ◽  
pp. 531-533 ◽  
Author(s):  
Daniel Popa ◽  
Mihaela Laszlo ◽  
Lidia Ciobanu ◽  
Elena Ucenic ◽  
Manuela Mihalache ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Toxic Megacolon ◽  
Fecal Microbiota ◽  
Recurrent Infections ◽  
Resonance Imaging ◽  
Vaginal Infection ◽  
Fecal Microbiota Transplant ◽  
Recurrent Clostridium Difficile Infection

A fecal microbiota transplant has proved to be an extremely effective method for patients with recurrent infections with Clostridium difficile. We present the case of a 65-year-old female patient with multiple Clostridium difficile infection (CDI) relapses on the rectal remnant, post-colectomy for a CDI-related toxic megacolon. The patient also evidenced associated symptomatic Clostridium difficile vaginal infection. She was successfully treated with serial fecal “minitransplants” (self-administered at home) and metronidazole ovules.Abbreviations: GI: gastrointestinal; MRI: magnetic resonance imaging; CDI: Clostridium difficile infection; FMT: fecal microbiota transplant.

scholarly journals The Impact of Changing to an Algorithm-Based Clostridioides difficile Test on the Decision to Treat Clostridioides difficile

2020 ◽  
Vol 41 (S1) ◽  
pp. s407-s407
Author(s):  
Lana Dbeibo ◽  
Joy Williams ◽  
Josh Sadowski ◽  
William Fadel ◽  
Vera Winn ◽  
...  
Keyword(s):  
Critical Care ◽  
Toxic Megacolon ◽  
Adverse Outcomes ◽  
Clinical Criteria ◽  
Testing Method ◽  
Clostridioides Difficile ◽  
Critical Care Admission ◽  
The Impact ◽  
Test Result ◽  
Pcr Test

Background: Polymerase chain reaction (PCR) testing for the diagnosis of Clostridioides difficile infection (CDI) detects the presence of the organism; a positive result therefore cannot differentiate between colonization and the pathogenic presence of the bacterium. This may result in overdiagnosis, overtreatment, and risking disruption of microbial flora, which may perpetuate the CDI cycle. Algorithm-based testing offers an advantage over PCR testing as it detects toxin, which allows differentiation between colonization and infection. Although previous studies have demonstrated the clinical utility of this testing algorithm in differentiating infection from colonization, it is unknown whether the test changes CDI treatment decisions. Our facility switched from PCR to an algorithm-based testing method for CDI in June 2018. Objective: In this study, we evaluated whether clinicians’ decisions to treat patients are impacted by a test result that implies colonization (GDH+/Tox−/PCR+ test), and we examined the impact of this decision on patient outcomes. Methods: This is a retrospective cohort study of inpatients with a positive C. diff test between June 2017 and June 2019. The primary outcome was the proportion of patients treated for CDI. We compared this outcome in 3 groups of patients: those with a positive PCR test (June 2017–June 2018), those who had a GDH+/Tox−/PCR+ or a GDH+/Tox+ test result (June 2018–June 2019). Secondary outcomes included toxic megacolon, critical care admission, and mortality in patients with GDH+/Tox−/PCR+ who were treated versus those who were untreated. Results: Of patients with a positive PCR test, 86% were treated with CDI-specific antibiotics, whereas 70.4% with GDH+/Tox+ and 29.25% with GDH+/Tox−/PCR+ result were treated (P < .0001). Mortality was not different between patients with GDH+/Tox−/PCR+ who were treated versus those who were untreated (2.7% vs 3.4%; P = .12), neither was critical care admission within 2 or 7 days of test result (2% vs 1.4%; P = .15) and (4.1% vs 5.4%, P = .39), respectively. There were no cases of toxic megacolon during the study period. Conclusions: The change to an algorithm-based C. difficile testing method had a significant impact on the clinicians’ decisions to treat patients with a positive test, as most patients with a GDH+/Tox−/PCR+ result did not receive treatment. These patients did not suffer more adverse outcomes compared to those who were treated, which has implications for testing practices. It remains to be explored whether clinicians are using clinical criteria to decide whether or not to treat patients with a positive algorithm-based test, as opposed to the more reflexive treatment of patients with a positive PCR test.Funding: NoneDisclosures: None

scholarly journals Management of Severe Attacks of Ulcerative Colitis with New Technologies

1990 ◽  
Vol 4 (7) ◽  
pp. 347-349
Author(s):  
M Campieri ◽  
P Gionchetti ◽  
A Belluzzi ◽  
M Tampieri ◽  
C Brignola ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Transverse Colon ◽  
Bowel Wall ◽  
New Technologies ◽  
Toxic Megacolon ◽  
Abdominal Ultrasound ◽  
Histological Evaluation ◽  
Excellent Correlation ◽  
Severe Ulcerative Colitis ◽  
Descending Colon

Barium enema and colonoscopy are contraindicated in severe attacks of ulcerative colitis because of the possibility of toxic megacolon and perforation. The authors have assessed abdominal ultrasound in 38 patients with severe ulcerative colitis. Ultrasound revealed bowel wall thicknesses ranging from 3.9 to 9.2 mm (mean 7.7) extending the whole length of the colon, to the transverse colon, and to the descending colon, respectively, in 18, 10 and eight patients. The degree of bowel thickening was related to the severity of inflammation based on clinical, sigmoidoscopic and histological evaluation. In two patients, ultrasound showed a thin bowel wall distended without motility, suggesting the diagnosis of toxic megacolon (confirmed radiologically). An excellent correlation (95%) was found between ultrasound and technetium-99 scanning. Ultrasound might be a reasonable first investigation in the assessment of patients with severe ulcerative colitis.

Recommendations for Surveillance of Clostridium difficile–Associated Disease

2007 ◽  
Vol 28 (2) ◽  
pp. 140-145 ◽  
Author(s):  
L. Clifford McDonald ◽  
Bruno Coignard ◽  
Erik Dubberke ◽  
Xiaoyan Song ◽  
Teresa Horan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Clostridium Difficile ◽  
Pseudomembranous Colitis ◽  
Ad Hoc ◽  
Toxic Megacolon ◽  
Healthcare Facility ◽  
Case Patient ◽  
Healthcare Settings ◽  
Community Onset ◽  
Laboratory Assay

Background.The epidemiology of Clostridium difficile-associated disease (CDAD) is changing, with evidence of increased incidence and severity. However, the understanding of the magnitude of and reasons for this change is currently hampered by the lack of standardized surveillance methods.Objective and Methods.An ad hoc C. difficile surveillance working group was formed to develop interim surveillance definitions and recommendations based on existing literature and expert opinion that can help to improve CDAD surveillance and prevention efforts.Definitions and Recommendations.A CDAD case patient was defined as a patient with symptoms of diarrhea or toxic megacolon combined with a positive result of a laboratory assay and/or endoscopic or histopathologic evidence of pseudomembranous colitis. Recurrent CDAD was defined as repeated episodes within 8 weeks of each other. Severe CDAD was defined by CDAD-associated admission to an intensive care unit, colectomy, or death within 30 days after onset. Case patients were categorized by the setting in which C. difficile was likely acquired, to account for recent evidence that suggests that healthcare facility-associated CDAD may have its onset in the community up to 4 weeks after discharge. Tracking of healthcare facility–onset, healthcare facility–associated CDAD is the minimum surveillance required for healthcare settings; tracking of community–onset, healthcare facility–associated CDAD should be performed only in conjunction with tracking of healthcare facility–onset, healthcare facility–associated CDAD. Community–associated CDAD was defined by symptom onset more than 12 weeks after the last discharge from a healthcare facility. Rates of both healthcare facility–onset, healthcare facility–associated CDAD and community–onset, healthcare facility–associated CDAD should be expressed as case patients per 10,000 patient–days; rates of community-associated CDAD should be expressed as case patients per 100,000 person-years.

scholarly journals Characterization of clinical Clostridium difficile isolates by PCR ribotyping and detection of toxin genes in Austria, 2006–2007

2008 ◽  
Vol 57 (6) ◽  
pp. 702-708 ◽  
Author(s):  
A. Indra ◽  
D. Schmid ◽  
S. Huhulescu ◽  
M. Hell ◽  
R. Gattringer ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Pseudomembranous Colitis ◽  
Antimicrobial Agents ◽  
Toxic Megacolon ◽  
Health Care Facilities ◽  
Reference Laboratory ◽  
Specimen Collection ◽  
Pcr Ribotyping ◽  
High Level

In order to assess the lethality of Clostridium difficile-associated disease (CDAD) and the PCR ribotypes prevalent in Austria, the Austrian Agency for Health and Food Safety requested isolates of C. difficile from patients in a structured but arbitrary sampling scheme. In the allocated period from February 2006 to January 2007, local hospital laboratories within each of the nine provinces were asked to submit C. difficile isolates from at least ten cases of CDAD. Confirmation of species identification, toxin detection, susceptibility testing against four antimicrobial agents and typing using a PCR ribotyping method were performed at the reference laboratory. In total, 149 isolates of putative C. difficile were submitted, from which 142 were included for study. Antimicrobial susceptibility patterns revealed resistance to clindamycin in 57 % and high-level resistance to moxifloxacin in 38 % of isolates tested. CDAD manifested as diarrhoea (including eight cases of bloody diarrhoea) in 126 cases (88.7 %), as pseudomembranous colitis in 15 cases (10.6 %) and as toxic megacolon in one case. Twelve of the 142 patients died within 30 days of specimen collection (8.45 % lethality). A lethal outcome occurred in 2/15 cases (13.3 %) when pseudomembranous colitis was present and in 10/126 cases (7.9 %) in the absence of pseudomembranous colitis or toxic megacolon. Among the 142 isolates from 25 health-care facilities, 41 PCR ribotype patterns were found. The most frequent ribotypes were AI-5 (including six lethal cases out of 26 patients), 014 (two out of 24) and 053 (one out of 24). The typing patterns demonstrated the occurrence of clusters in hospitals.

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