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. 1983 Mar;24(3):206–212. doi: 10.1136/gut.24.3.206

Relapse of antibiotic associated colitis: endogenous persistence of Clostridium difficile during vancomycin therapy.

B A Walters, R Roberts, R Stafford, E Seneviratne
PMCID: PMC1419935  PMID: 6826104

Abstract

This study reports 24 patients with antibiotic associated colitis due to Clostridium difficile. Fifteen patients were treated with vancomycin due to the severity of the colitis and in eight of these a clinical relapse of the colitis occurred after vancomycin therapy was stopped. Bacteriological investigations of these patients indicated that C difficile was able to persist in stool samples during vancomycin therapy in the absence of detectable cytotoxin. This was in contrast with the seven patients successfully treated with vancomycin without relapse, and those not treated with vancomycin where both stool cultures and cytotoxin assays became negative. These results suggest that patients being treated with vancomycin for antibiotic associated colitis due to C difficile should have stool cultures done during and after treatment. Persistence of the organism in the absence of detectable cytotoxin may identify those patients who relapse and lead to either recommencement of vancomycin or alternative therapeutic approaches.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bartlett J. G., Tedesco F. J., Shull S., Lowe B., Chang T. Symptomatic relapse after oral vancomycin therapy of antibiotic-associated pseudomembranous colitis. Gastroenterology. 1980 Mar;78(3):431–434. [PubMed] [Google Scholar]
  2. Chang T. W., Lauermann M., Bartlett J. G. Cytotoxicity assay in antibiotic-associated colitis. J Infect Dis. 1979 Nov;140(5):765–770. doi: 10.1093/infdis/140.5.765. [DOI] [PubMed] [Google Scholar]
  3. Dinh H. T., Kernbaum S., Frottier J. Treatment of antibiotic-induced colitis by metronidazole. Lancet. 1978 Feb 11;1(8059):338–339. doi: 10.1016/s0140-6736(78)90119-8. [DOI] [PubMed] [Google Scholar]
  4. George W. L., Sutter V. L., Citron D., Finegold S. M. Selective and differential medium for isolation of Clostridium difficile. J Clin Microbiol. 1979 Feb;9(2):214–219. doi: 10.1128/jcm.9.2.214-219.1979. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. George W. L., Volpicelli N. A., Stiner D. B., Richman D. D., Liechty E. J., Mok H. Y., Rolfe R. D., Finegold S. M. Relapse of pseudomembranous colitis after vancomycin therapy. N Engl J Med. 1979 Aug 23;301(8):414–415. doi: 10.1056/NEJM197908233010806. [DOI] [PubMed] [Google Scholar]
  6. Hafiz S., Oakley C. L. Clostridium difficile: isolation and characteristics. J Med Microbiol. 1976 May;9(2):129–136. doi: 10.1099/00222615-9-2-129. [DOI] [PubMed] [Google Scholar]
  7. Kabins S. A., Spira T. J. Outbreak of clindamycin-associated colitis. Ann Intern Med. 1975 Dec;83(6):830–831. doi: 10.7326/0003-4819-83-6-830. [DOI] [PubMed] [Google Scholar]
  8. Keighley M. R., Burdon D. W., Arabi Y., Williams J. A., Thompson H., Youngs D., Johnson M., Bentley S., George R. H., Mogg G. A. Randomised controlled trial of vancomycin for pseudomembranous colitis and postoperative diarrhoea. Br Med J. 1978 Dec 16;2(6153):1667–1669. doi: 10.1136/bmj.2.6153.1667. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Keighley M. R., Burdon D. W., Mogg G. A., George R. H., Alexander-Williams J., Thompson H. Pseudomembranous colitis. Lancet. 1979 Mar 10;1(8115):559–560. doi: 10.1016/s0140-6736(79)90989-9. [DOI] [PubMed] [Google Scholar]
  10. Kim K. H., Fekety R., Batts D. H., Brown D., Cudmore M., Silva J., Jr, Waters D. Isolation of Clostridium difficile from the environment and contacts of patients with antibiotic-associated colitis. J Infect Dis. 1981 Jan;143(1):42–50. doi: 10.1093/infdis/143.1.42. [DOI] [PubMed] [Google Scholar]
  11. Kreutzer E. W., Milligan F. D. Treatment of antibiotic-associated pseudomembranous colitis with cholestyramine resin. Johns Hopkins Med J. 1978 Sep;143(3):67–72. [PubMed] [Google Scholar]
  12. Modigliani R., Delchier J. C. Vancomycin for antibiotic-induced colitis. Lancet. 1978 Jan 14;1(8055):97–98. doi: 10.1016/s0140-6736(78)90034-x. [DOI] [PubMed] [Google Scholar]
  13. Mulligan M. E., George W. L., Rolfe R. D., Finegold S. M. Epidemiological aspects of Clostridium difficile-induced diarrhea and colitis. Am J Clin Nutr. 1980 Nov;33(11 Suppl):2533–2538. doi: 10.1093/ajcn/33.11.2533. [DOI] [PubMed] [Google Scholar]
  14. Onderdonk A. B., Bartlett J. G. The biological and clinical significance of Clostridium difficile. Crit Rev Clin Lab Sci. 1981;13(3):161–172. doi: 10.3109/10408368109106446. [DOI] [PubMed] [Google Scholar]
  15. Onderdonk A. B., Lowe B. R., Bartlett J. G. Effect of environmental stress on Clostridium difficile toxin levels during continuous cultivation. Appl Environ Microbiol. 1979 Oct;38(4):637–641. doi: 10.1128/aem.38.4.637-641.1979. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Roberts R. K., Seneviratne E. Vancomycin therapy Clostridium difficile. Med J Aust. 1980 Jul 26;2(2):98–98. doi: 10.5694/j.1326-5377.1980.tb76903.x. [DOI] [PubMed] [Google Scholar]
  17. Ryan R. W., Kwasnik I., Tilton R. C. Rapid detection of Clostridium difficile toxin in human feces. J Clin Microbiol. 1980 Dec;12(6):776–779. doi: 10.1128/jcm.12.6.776-779.1980. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Saginur R., Hawley C. R., Bartlett J. G. Colitis associated with metronidazole therapy. J Infect Dis. 1980 Jun;141(6):772–774. doi: 10.1093/infdis/141.6.772. [DOI] [PubMed] [Google Scholar]
  19. Tedesco F., Markham R., Gurwith M., Christie D., Bartlett J. G. Oral vancomycin for antibiotic-associated pseudomembranous colitis. Lancet. 1978 Jul 29;2(8083):226–228. doi: 10.1016/s0140-6736(78)91741-5. [DOI] [PubMed] [Google Scholar]
  20. Walters B. A., Stafford R., Roberts R. K., Seneviratne E. Contamination and crossinfection with Clostridium difficile in an intensive care unit. Aust N Z J Med. 1982 Jun;12(3):255–258. doi: 10.1111/j.1445-5994.1982.tb02471.x. [DOI] [PubMed] [Google Scholar]
  21. Wilkins T. D., Thiel T. Modified broth-disk method for testing the antibiotic susceptibility of anaerobic bacteria. Antimicrob Agents Chemother. 1973 Mar;3(3):350–356. doi: 10.1128/aac.3.3.350. [DOI] [PMC free article] [PubMed] [Google Scholar]

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