Pseudomembranous Colitis

While antibiotics have benefits, the trouble with antibiotics is that the medicine doesn’t just kill the bad bacteria causing an infection that is being treated. They also kill good bacteria that live in our gut. This can lead to an imbalance in the microbiome, also termed dysbiosis, which can lead to gastrointestinal symptoms. WHAT IS PSEUDOMEMBRANOUS COLITIS? Pseudomembranous colitis, also called “antibiotics associated colitis“ or “c. difficile colitis“, is inflammation of the colon associated with an overgrowth of bacterium clostridioides difficile (formally clostridium difficile), often called “c.diff”.  Pseudomembranous colitis happens when there are too many c.diff bacteria in the intestine after taking antibiotics. This overgrowth of c.difficile is often linked to a recent hospital stay or antibiotic treatment. C.difficile infections are more common in people over 65 years old. C.Difficile And Its Habitat Clostridium difficile is a germ that causes severe diarrhea and colitis. 

1. difficile lives in soil, air, water, and feces and sometimes in foods like processed meats. For this reason, the bacteria can easily distribute themselves on diverse surfaces. 

Its presence is felt in the many medical diagnosing laboratories, research labs. You can get it when you touch a surface that has the bacteria on it and then put your hand near or in your mouth.  Most times contaminated hands or items assist in its speedy spread. Once it is in your body, c.diff makes a kind of poison to your systems.  More susceptible groups are the healthcare workers, pathological workers, forensic technologists, and waste workers. C.difficile is known to be resistant to multiple antibiotics. It is estimated to cause almost half a million infections in the United States each year.  There is an emergence of a new strain of an aggressive c.diff that produces far more toxins than the other previous strains do. The new strain may be more resistant to certain medications, including antibiotics.  RISK FACTORS ASSOCIATED WITH PSEUDOMEMBRANOUS COLITIS Some factors which might increase your complications and risks of pseudomembranous colitis include all or some of the following as mentioned below: 

• Taking antibiotics.
• Staying in hospital or nursing home.
• Aging, especially over 65 years.
• Undergoing other digestive problems like Crohn’s disease or ulcerative colitis.
• Using medicines that reduce stomach acid.
• Sickness or a weakened immune system.
• Past digestive system surgery.
• Chemotherapy.

COMPLICATIONS OF PSEUDOMEMBRANOUS COLITIS PMC can be life-threatening, if not properly attended to. Some complications that may arise from PMCs include the following:

• Dehydration.
• Severe diarrhea can lead to loss of fluids and electrolytes.
• Toxin megacolon.
• This is a rare condition in which the sufferer’s colon is unable to expel gas or defecate. 
• Bowel perforation.
• This is a hole in one’s large intestine. It can lead to a life-threatening infection known as peritonitis.
• Kidney failure.
• Dehydration can retard kidney functions.
• Death.
• Mild to moderate c.diff infections can quickly lead to fatal or deadly diseases.

DIAGNOSIS Test and procedures used to diagnose PMC include:

• Stool sample
• Blood Tests. 

Very high WBC count indicates  infection like c.diff

• Colonoscopy Or Sigmoidoscopy. 

To examine the inside of your colon for signs of PMC–raised, yellow plaques (lesions), and swellings.

• Imaging Tests. 

Abdominal X-ray or abdominal CT Scan to look for signs of toxic med colon or colon rupture. TREATMENT Treatment aims at treating the infection and restoring health. 

1. Stop administration of antibiotics or switch to one that treats this infection (c.difficile). 

You may be given antibiotics by mouth, through a vein, or a tube inserted through the nose into the stomach (nasogastric tube).  Vancomycin or fidaxomicin (Dficid) is most often used. If they are not available or cannot be related, then metronidazole (Flagyl) may be used.  For severe conditions, your doctor may recommend vancomycin by mouth together with intravenous metronidazole or a vancomycin enema.

1. Having fecal microbial transplantation (FMT). 

Having a stool transplant from a healthy donor to restore the balance of healthy bacteria in your colon.  The donor stool may be given through a nasogestine tube, inserted into the colon, or placed in a capsule you swallow.  Treating Recurring Pseudomembranous Colitis The natural occurrence of new, more aggressive strains of c.difficile, which are more resistant to antibiotics, has been difficult in treating pseudomembranous colitis (PMC) and has made recurrence more common. And it seems one recurrence, may create a chance of having another recurrence, and so on. Treatment options may include:

• A repeat of antibiotics.

A second or third round of antibiotics may resolve your condition. A long duration of therapy may also be recommended. With patients having progress organ failure, rupture of the colon, and inflammation of the lining of the abdominal wall peritonitis, surgery may be an option.

• Fecal microbial transplantation (FMT)
• Bezlotoxumab (Zinplava) 

The FDA has approved the use of human monoclonal antibody bezlotoxumab to reduce the risk of c.difficile infection recurrence. The use of bezlotoxumab in combination with antibiotics has proven to significantly reduce the reoccurrence of infection. But the cost has posed a great challenge. PREVENTION OF ANTIBIOTIC-ASSOCIATED COLITIS To help curtail the spread of c.diff, hospitals and other healthcare centers, and individuals should follow strict infection-control guidelines towards the prevention of PMCs.  Such preventive measures include all of the below:

• Hand Washing

Healthcare workers should practice good hand hygiene before and after treating each patient. During a c.diff outbreak, using soap and warm water is a better choice for hand hygiene.   Alcohol–based hand sanitizers don’t effectively destroy c.diff spores. visitors should do likewise before and after leaving the room or using the convenience. Visitors in hospitals and other forms of healthcare centers should equally wash their hands before and after leaving the room or using the restroom.

• Contact Precaution

Hospitalized c.diff patients should have private rooms or share a room with another c.diff patient. Hospital staff and visitors wear disposable gloves and isolation gowns while in the room until at least 48 hours after the end of diarrhea.

• Thorough Cleaning

All surfaces should be disinfected with a product that contains chlorine this infection (c.difficile) bleach.

• Avoid unnecessary use of antibiotics. Always seek the attention of your doctor.

LIFESTYLE AND HOME REMEDIES

• Use of supplement: Concentrated supplements of good bacteria and yeasts (probiotics) can help prevent c.difficile. They are available in capsule or liquid form.
• Drink plenty of fluids: Water and fluids with added sodium and potassium (electrolyte) are beneficial to cope with diarrhea and dehydration. 

Such fluids include sports drinks (Gatorade, Powerade, others), oral rehydration solutions (Pedialyte, Caralyte, others), fruit juices, non-caffeinated soft drinks, and broths. Avoid beverages that contain much sugar, alcohol, or caffeine.

• Avoid irritating foods such as spicy, fatty, or fried foods. Or any others that worsen your symptoms.

MORTALITY RATE Based on the research project conducted by Sailhemer et al as defined by the need for colectomy or admission to the intensive care unit, the in-hospital mortality rate for fulminate c.difficile colitis was 34.7%.

Symptoms

SYMPTOMS OF PSEUDOMEMBRANOUS COLITIS

Signs and symptoms of antibiotic-associated colitis may include the following health conditions:

• Fever
• Nausea
• Watery diarrhea
• Pain or tenderness
• Abdominal cramps
• Pus or mucus in your stool
• Dehydration

And in more serious cases, you may also have:

• Low heart rate
• Low blood pressure
• Weak pulse.

Causes

CAUSES OF PSEUDOMEMBRANOUS COLITIS

When afflicted with germs such as the c.diff bacteria, there are good bacteria in your colon, which keep the amount of c.diff in your body under control; but antibiotics can kill the good bacteria and consequently let c.diff grow way too fast. The antibiotic-resistant c.difficile gains dominion and afterward, damage your colon, causing antibiotic-related colitis.

Antibiotic-associated colitis or pseudomembranous colitis [PMC] occurs when an administered antibiotic destroys the healthy bacteria that keep the clostridium difficile bacteria in check, making the c.diff grow too fast in retaliation, thereby damaging your colon.

The main or predominant causes of PMC include all of the following stated below:

• Antibiotics.
• Almost all activities can cause PMCs, but some are more commonly linked to this colitis than others. Such antibiotics include:
• Penicillin, such as amoxicillin and ampicillin.
• Fluoroquinolones, such as ciprofloxacin [Cipro] and levofloxacin.
• Clindamycin [Cleocin].
• Cephalosporins, such as cefixime [Suprax].
• Chemotherapy drugs are used to treat cancer.
• Certain digestive system diseases, such as:
• Ulcerative colitis.
• Crohn’s disease.
• Community-acquired transmission.
• PMCs are transmitted from one person to another, such as from healthcare workers to patients, and vice versa.

FAQ

What causes antibiotics-associated colitis?

Antibiotics-associated colitis is an inflammation of the large intestine. It happens when there is too much Clostridium difficile (c.diff) bacteria in the intestine after taking antibiotics.

How do I heal my gut after antibiotics?

Taking probiotics during and after a course of antibiotics can help reduce the risk of diarrhea and restore your gut microbiota to a healthy state. What’s more, eating high-fiber foods, fermented foods, and prebiotic foods after taking antibiotics may also help reestablish a healthy gut microbiota.

What is the strongest natural antibiotic?

Oregano oil is one of the most powerful antibacterial and antifungal compounds. Research shows oregano oil is effective against many clinical strains of bacteria, including E-coli.

What is the best probiotic to take after antibiotics?

Recent studies have found that probiotic isolates such as Lactobacillus reuteri may offer a powerful weapon against dangerous antibiotics resistant bacteria such as clostridium difficile, Pseudomonas aeruginosa, Escherichia coli, and Klebsiella pneumonia.

What happens when antibiotics kill your good bacteria?

While antibiotics have benefits, the trouble with antibiotics is that the medicine doesn’t just kill the bad bacteria causing an infection that is being treated. They also kill good bacteria that live in our gut. This can lead to an imbalance in the microbiome, also termed dysbiosis, which can lead to gastrointestinal symptoms.