19th July 2023

Pseudomembranous Colitis

Pseudomembranous colitis is acute inflammation of the colon secondary to infection with Clostridium difficile – a gram positive toxin-producing anaerobic rod. It has a strong association with prolonged use of broad-spectrum antibiotics, which disrupt the normal bowel flora and allow Clostridium difficile to colonise. The most common culprit antibiotics are 3rd/4th generation cephalosporins, ciprofloxacin, clindamycin, carbapenems and broad-spectrum penicillins. Other risk factors include increased age, prolonged hospital stay, PPI use, immunosuppression and previous Clostridium difficile infection. Symptoms include new onset pungent diarrhoea, abdominal pain, fever, nausea and vomiting. The classification of Clostridium difficile infection severity is shown in table 3:

Table 3: Public Health England Classification of Clostridium difficile Infection Severity

Stool samples should be sent for PCR and enzyme immunoassay in all suspected cases of Clostridium difficile. If clinical signs suggest toxic megacolon or bowel perforation, abdominal imaging is necessary. Patients need to be isolated with enhanced PPE for contacts and handwashing with soap and water until 48 hours after diarrhoea has resolved. Care is supportive, with antimicrobial use guided by frequency of reinfection, as shown in table 4.

Table 4: Management of Clostridium difficile Infection in Adults