Pseudomembranous colitis: isolation of two species of cytotoxic clostridia and successful treatment with vancomycin

• Published in: Canadian Medical Association journal Vol. 119; no. 9; pp. 1058 - 1060
• Main Authors: Marrie, T. J, Faulkner, R. S, Badley, B. W, Hartlen, M. R, Comeau, S. A, Miller, H. R
• Format: Journal Article
• Language: English
• Published: Canada Can Med Assoc 04-11-1978
• Subjects: Aged; Animals; Clostridium - drug effects; Clostridium - isolation & purification; Clostridium Infections - drug therapy; Clostridium Infections - etiology; Clostridium Infections - microbiology; Cricetinae; Culture Techniques; Diabetes Complications; Drug Resistance, Microbial; Enterocolitis, Pseudomembranous - drug therapy; Enterocolitis, Pseudomembranous - etiology; Enterocolitis, Pseudomembranous - microbiology; Feces - microbiology; Female; Humans; Leg Ulcer - drug therapy; Lincomycin - therapeutic use; Vancomycin - therapeutic use
• ISSN: 0008-4409

Lincomycin-resistant Clostridium sporogenes obtained from the stools of a patient with lincomycin-associated pseudomembranous colitis produced a heat-stable cytotoxin in low titre when grown in chopped meat medium. Vancomycin eradicated this strain and all other clostridia, and controlled the symptoms. When diarrhea recurred 7 days after treatment with vancomycin was stopped, clostridia including C. sporogenes and C. difficile were again isolated. The C. difficile produced a heat-labile cytotoxin in high titre that was unaffected by growth in various media and induced colitis in hamsters. Treatment with vancomycin, to which all the clostridia were sensitive, eradicated both toxic species and controlled the diarrhea. Antibiotic-induced pseudomembranous colitis may be associated with more than one species of toxin-producing clostridia. Vancomycin therapy should be continued for 10 days or more in patients with severe disease to eradicate the responsible organism.