How to identify the cause of antibiotic-associated diarrhea.
ABSTRACT Most cases of antibiotic-associated diarrhea are due to Clostridium difficile or are of enigmatic etiology. The antibiotics most often implicated are clindamycin, ampicillin or amoxicillin, and the cephalosporins. Clinical signs of antibiotic-associated diarrhea may be limited to watery stools; however, evidence of colitis (fever, cramps, leukocytosis, fecal leukocytes) suggests C. difficile infection. The tissue culture assay for C. difficile toxin remains the gold standard for diagnosis, but the enzyme immunoassay is a practical and reasonably accurate alternative. Anatomic changes, such as pseudomembranes, can be confirmed with endoscopy, but such evaluation is not required for diagnosis of C. difficile-associated pseudomembranous colitis.
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- "There is conflicting evidence regarding the use of FLT as a screening test for CDAD. While the studies done by Savola et al , Mark et al , Manabe et al  and Shanholtzer et al  concluded FLT as a poor predictor of CDAD; studies done by Bartlett et al  and Fekety et al  proposed that FLT might be a useful predictor in CDAD. The results of our study reinforce the fact that FLT is a poor predictor of CDAD; because 70% of stool specimens positive for C. difficile toxin are negative for fecal leukocyte. "
ABSTRACT: Fecal leukocyte test (FLT) is widely used to screen for invasive diarrheas including C. difficile associated diarrhea (CDAD), which account for more than 25 % of all antibiotic associated diarrhea. 263 stool samples from patients with suspected CDAD were studied simultaneously for fecal leukocyte test (FLT) and Clostridium difficile toxin assay (CDTA). FLT was performed by the Giemsa technique and CDTA was performed by enzyme immuno assay (EIA). Sensitivity, specificity, positive predictive value and negative predictive value of FLT as compared to CDTA were 30%, 74.9%, 13.2% and 89.3% respectively. Considering the poor sensitivity of FLT, and the comparable cost and time of obtaining a CDTA at our institution, we conclude that FLT is not a good screening test for CDAD. Possible reasons for FLT being a poor predictor of CDTA are discussed.Annals of Clinical Microbiology and Antimicrobials 02/2006; 5:9. DOI:10.1186/1476-0711-5-9 · 1.51 Impact Factor
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ABSTRACT: We sought to describe the characteristics of patients who had Clostridium difficile colitis complicated by leukemoid reactions (total leukocyte count greater than 35 x 10(9)/L) and to determine whether this complication is associated with higher morbidity or mortality than C difficile colitis without leukemoid reactions. We performed a retrospective case series analysis of patients with a positive fecal assay for C difficile toxin and a peak leukocyte count greater than 35 x 10(9)/L during 1998 and 1999. Twenty cases that met these criteria were compared with 65 randomly selected control patients (patients with a positive C difficile toxin and a peak leukocyte count less than 35 x 10(9)/L). Results: The mean peak leukocyte count was 52 +/- 18.2 x 10(9)/L (+/- SD) in the case group and 14.9 +/- 6.5 x 10(9)/L in the control group. Patients with a leukemoid reaction had a lower temperature, a lower serum albumin level, and a higher hematocrit value. Multivariable logistic regression showed respiratory tract infection and lower temperature to be independent predictors of a leukemoid reaction. There were 10 deaths (50%) in the leukemoid reaction group and 5 deaths (7.7%) in the control group. All seven patients with a peak leukocyte count greater than 50 x 10(9)/L died, compared with eight deaths (10.3%) among the remaining 78 patients whose peak leukocyte count was less than 50 X 10(9)/L. Patients with C difficile colitis and a leukocyte count greater than 35 x 10(9)/L have a poor prognosis with a much higher mortality rate than patients who have C difficile colitis without a leukemoid reaction.Southern Medical Journal 11/2004; 97(10):959-63. DOI:10.1097/01.SMJ.0000054537.20978.D4 · 1.12 Impact Factor