title: Fulminant Clostridium difficile colitis: a complication of perioperative antibiotic prophylaxis.
abstract: Antibiotic prophylaxis for maxillofacial surgical wounds remains common practice. Surgeons must weigh the risks (e.g., Clostridium difficile colitis) against the benefits before administering antibiotics for any reason and the relative risk and morbidity of C difficile colitis against those of a potential postoperative wound infection. In addition, the possibility of C difficile infection as a complication of perioperative antibiotic prophylaxis should be discussed with patients before surgery, especially those with concomitant baseline risk factors. This report describes the case of a young healthy patient with few risk factors for C difficile infection who received a standard perioperative course of antibiotic therapy. Subsequently, the patient developed severe fulminant C difficile infection that required a protracted hospital admission, subtotal colectomy, and ileostomy. This case underscores that antibiotic prophylaxis continues in widespread use and is not benign therapy.
authors.affiliation: Chief Resident, Division of Oral and Maxillofacial Surgery, Department of Dentistry, University of Rochester Medical Center/Strong Memorial Hospital, Rochester, NY. Electronic address: donovan.hansen@gmail.com.
authors.forename: Donovan
authors.initials: D
authors.lastname: Hansen
authors.forename: Lee D
authors.initials: LD
authors.lastname: Pollan
authors.forename: Hiran
authors.initials: H
authors.lastname: Fernando
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D019072:Antibiotic Prophylaxis / Q000009:adverse effects*; D001426:Bacterial Proteins / Q000032:analysis; D001427:Bacterial Toxins / Q000032:analysis; D002437:Cefazolin / Q000009:adverse effects*; D016360:Clostridioides difficile / Q000502:physiology*; D003082:Colectomy; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis*; D004768:Enterotoxins / Q000032:analysis; D005260:Female; D005500:Follow-Up Studies; D005964:Glucosyltransferases / Q000032:analysis; D006801:Humans; D007081:Ileostomy; D045823:Ileus / Q000209:etiology; D008313:Malocclusion, Angle Class III / Q000601:surgery; D008437:Maxilla / Q000002:abnormalities / Q000601:surgery; D024343:Open Bite / Q000601:surgery; D056948:Orthognathic Surgical Procedures; D019340:Osteotomy, Le Fort / Q000379:methods; D011183:Postoperative Complications; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001427:Bacterial Toxins; D004768:Enterotoxins; C041348:tcdA protein, Clostridium difficile; C031815:toxB protein, Clostridium difficile; D005964:Glucosyltransferases; D002437:Cefazolin