title: Clostridium difficile 027-associated pseudomembranous colitis after short-term treatment with cefuroxime and cephalexin in an elderly orthopedic patient: a case report.
abstract: BACKGROUND
  Clostridium difficile ribotype 027 has become increasingly prevalent in European countries. The clinical picture varies from self-limiting diarrhea to pseudomembranous colitis with toxic megacolon and ultimately death. Use of antibiotics is the principal risk factor; others include comorbidity, advanced age and hospitalization. However even with extensive knowledge of risk factors, it remains difficult to define "minimum risk," as illustrated by the following case.
  
  
  METHODS
  An 80-year-old Danish man in good health was hospitalized for a penetrating knee injury. He received 5 days of intravenous cefuroxime after surgical revision and was discharged with oral cephalexin. Post-discharge he suffered from abdominal discomfort and was readmitted with ileus 4 days after discharge, i.e. 10 days after initiation of antibiotic treatment. His condition deteriorated, and pseudomembranous colitis was diagnosed. Due to lack of response to vancomycin and metronidazole, a total colectomy was performed. Stool cultures were positive for CD 027.
  
  
  CONCLUSIONS
  Short-term use of cephalosporins may have induced CD 027 infection, and the patient's age was the only identifiable risk factor for the fulminant course. Thus, even short-term prophylactic treatment with cephalosporins cannot be considered entirely safe.
authors.affiliation: Department of Clinical Microbiology, Aalborg Hospital, Aarhus University Hospital, Mølleparkvej 10 6 Sal, Aalborg DK- 9000, Denmark. kirstine.soegaard@dadlnet.dk
authors.forename: Kirstine Kobberøe
authors.initials: KK
authors.lastname: Søgaard
authors.forename: Tove
authors.initials: T
authors.lastname: Ejlertsen
authors.forename: Henrik Carl
authors.initials: HC
authors.lastname: Schønheyder
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002444:Cefuroxime / Q000009:adverse effects* / Q000627:therapeutic use; D002506:Cephalexin / Q000009:adverse effects* / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000302:isolation & purification* / Q000472:pathogenicity; D004761:Enterocolitis, Pseudomembranous / Q000139:chemically induced* / Q000382:microbiology; D006801:Humans; D008297:Male; D012307:Risk Factors
chemical_list: D002444:Cefuroxime; D002506:Cephalexin