Clostridium difficile MCQs
A 45 year old woman undergoes an uneventful laparoscopic cholecystectomy for which she receives one dose of cephalosporin. One week later, she returns to the emergency room with fever, nausea, and copious diarrhea and is subsequently diagnoed with peudomembranous colitis. With respect to this disease, which one of the following statements is correct?
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a. Surgical intervention is frequently required
b. After appropriate antibiotic therapy, the relapse rate is less than 5%
c. Tissue culture assay for C. difficile toxin B is neither sensitive nor specific; therefore, diagnosis should be based on clinical findings
d. If surgery is performed, a left hemicolectomy is usually adequate to treat pseudomembranous coliti
e. Indications for surgical treatment include intractable disease, failure of medical therapy, toxic megacolon, and colonic perforation
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The answer is e. (Brunicardi, p. 1100)
Indications for surgical treatment of C. difficile colitis are intractable disease, failure of medical therapy, toxic megacolon, and colonic perforation; surgical therapy consists of subtotal colectomy with end ileostomy.
The diagnosis can be made by either detection of the characteristic appearance of pseudomembranes on endoscopy or detectionof either toxin A or toxin B in the stool.
Treatment is metronidazole for first-line therapy and oral vancomycin as a second tier agent.
Recurrence appears in up to 20% of patients.
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Categorised as: Clostridium difficile