Two cases of antibiotic-associated colitis due to a toxin produced by Clostridium difficile we rereported.
Case 1: A 55-year-old man underwent left ureterolithotomy and indwelt a catheter in left ureter under diagnosis of left ureteral stone and suspicion of tuberculous ureteral stricture. Although chemotherapy with several kinds of antibiotics was performed against fever after operation, he did not become afebrile completely. On the 37th day after operation perforation of transverse colon was detected by laparotomy. After laparotomy cefazolin was administrated for fever and faint dia rrheawas developed. On the 17th day after laparotomy stool examination was performed and C. difficile (10
7 cfu/g) and its toxin with high titer were detected.
Case 2: A 68-year-old man underwent partinal cystectomy for bladder carcinoma. Fever was developed after operation and two times of oral administration of amoxicillin on the 3rd day after operation caused an elevation of temperature and diarrhea. Stool culture on the 5th day after operation revealed C. difficile (10
6 cfu/g) with Klebsiella pneumoniae (10
5 cfu/g) and a toxin of C. difficile with high titer was also detected.
High grade toxigenicity of two strains of C. difficile isolated from these two patients was substantiated with cytotoxicity in Hela cells, lethal toxicity in mouse and vascular permiability factor in rabbit.
Metronidazol and rifampicin showed high activities against two strains isolated, both of which were generally resistant to the antibiotics used for the treatment before C. difficile isolation.
Antibiotic-associated colitis due to a toxin of C. difficile as reported herein would become one of the problems in use of broad spectrum antibiotics, especially active against anaerobes.
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