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Antimicrobial Agents Associated Pseudomembranous Colitis T. Inamatsu 1 , K. Shimada 1 , K. Urayama 1 , K. Adachi 2 , K. Tanaka 2 , Y. Hino 3 , T. Muto 4 1Department of Internal Medicine, Tokyo Metropolitan Geriatric Hospital 4The First Department of Surgery, Faculty of Medicine, University of Tokyo pp.117-124
Published Date 1983/2/25
DOI https://doi.org/10.11477/mf.1403109270
  • Abstract
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 Pathogenic roles of Clostridium difficile, colonoscopic findings, clinical features and efficacy of oral vancomycin therapy were studied on antimicrobial agents associated diarrhea-pseudomembranous colitis in aged patients.

 Clostridium difficile was isolated from 31 of 54 patients with antimicrobial agents associated diarrhea, and from all of 17 patients with pseudomembranous colitis confirmed by colonoscopic study. Colonoscopic findings of patients with Clostridium difficile isolation showed wide spectrum of inflammatory changes from multiple plaque-like pseudomembrane formation to minor redness and/or edema. Pseudomembranous colitis seems to be a severe form of colitis by toxinproducing Clostridium difficile.

 Clinical features of 33 cases with pseudomembranous colitis which was confirmed by colonoscopy (22 cases) or autopsy (11 cases) were studied. Implicated antimicrobials were cephems, lincomycin, penicillins with broad spectrum, quinolincarbonates and rifampicin in 18, 11, 5, 2 and 1 patients respectively. One to 17 days after the start of causative antimicrobials, various frequency and quality of diarrhea occurred. Fever higher than 38℃, and leucocytosis more than 10,000/cmm were observed in 75.9% and 75.9% respectively. Hypoproteinemia (<5.5g/dl), hyponatremia (<137mEq/l) and hypokalemia (<3.3mEq/l) were observed in 65.5, 51.7 and 37.9% of cases respectively.

 Eleven patients diagnosed by autopsy did not discontinue the implicated antimicrobials after the onset of diarrhea, and died on the fourth to 42th day. Thirteen patients diagnosed by endoscopy and treated without vancomycin recovered completely in 30.5 days on an average after the cessation of the implicated antimicrobials. Three of them died of underlying diseases or complications with resolution of colitis. On the other hand, nine patients treated with oral vancomycin recovered completely in 13.9 days on an average.


Copyright © 1983, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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