歯性感染症の患者に生じた抗菌薬関連出血性大腸炎の1例

抄録

Hemorrhagic colitis due to antibiotics has increased with the widespread use of antibiotics for various diseases. The clinical features included sudden onset a few days after the administration of antibiotics, abdominal pain and bloody diarrhea.

　We report herein on a case of antibiotic-associated hemorrhagic colitis (AAHC) following administration of sulbactam /ampicillin (SBT/ABPC). A 73-year-old female diagnosed with left cheek cellulitis with a complaint of left cheek swelling received an intravenous infusion of SBT / ABPC.

　Three days after administration, severe abdominal pain and watery bloody diarrhea developed. Intestinal wall thickening in the ascending, transverse and sigmoid colon without evidence of appendicitis, intestinal necrosis, or abdominal mass was observed on computed tomography without contrast material.

　Gram’s staining revealed dominantly gram negative rods in the feces and the cultures were positive for Klebsiella oxytoca (KO). Clostridium difficile (CD) antigen was negative in the feces. The fever and abdominal pain gradually improved with conservative treatment, including the withdrawal of antibiotics after a gastroenterology consultation, and the bloody diarrhea had resolved within a week. Twelve days following treatment, the symptoms had improved and abdominal ultrasonography showed improved mucosal edema in the ascending, transverse and sigmoid colon, and she was discharged three days later. The patient was followed up for one month, and she showed good progress without a recurrence of inflammation.