Pseudomembranous colitis superinfection

Therapy with cephalosporins may result in a bacterial or fungal superinfection. Diarrhea may be an indication of pseudomembranous colitis, which is one type of bacterial superinfection. See Chapter 7 for a discussion of bacterial and fungal superinfections and pseudomembranous colitis. 

DIARRHEA. Frequent liquid stools may be an indication of a superinfection or pseudomembranous colitis. If pseudomembranous colitis occurs, it is usually seen 4 to 10 days after treatment is started. 

The nurse inspects each bowel movement and immediately reports to the primary health care provider the occurrence of diarrhea or loose stools containing blood and mucus because it may be necessary to discontinue the drug use and institute treatment for diarrhea, a superinfection, or pseudomembranous colitis. 

DIARRH EA. Diarrhea may be an indication of a superinfection or pseudomembranous colitis, both of which can be serious. The nurse should inspect all stools for the presence of blood or mucus. If diarrhea does occur and there appears to be blood and mucus in the stool, the nurse saves a sample of the stool and tests for occult blood using a test such as Hemoccult. If the stool tests positive for blood, the nurse saves the stool for possible further laboratory analysis. 

Bacterial or fungal superinfections and pseudomembranous colitis (see Chap. 7) may occur with the use of both of these drugs. The administration of any drug may result in a hypersensitivity reaction, which can... 

MANAGING DIARRHEA. Diarrhea may be a sign of a superinfection or pseudomembranous colitis, both of which are adverse reactions tiiat may be seen with the administration of any anti-infective. The nurse checks each stool and reports any changes in color or consistency. When vancomycin is given as part of the treatment for pseudomembranous colitis, it is important to record the color and consistency of each stool to determine the effectiveness of therapy. 

Monitor the patient for the development of potential complications of treatment such as delayed hypersensitivity reactions, antibiotic-induced diarrhea, pseudomembraneous colitis, or fungal superinfections (manifested as oral thrush). 

Penicillins alter the normal bacterial flora in areas of the body, including the respiratory and intestinal tracts. Patients taking oral penicillins may experience nausea, vomiting, or diarrhea. This is usually of little clinical significance because the normal microflora reestablishes itself quickly after cessation of therapy. However, serious superinfection with resistant organisms such as Pseudomonas, Proteus, or Candida can follow long-term therapy with any penicillin. Superinfection with Clostridium difficile can lead to potentially fatal pseudomembranous colitis. 

Superinfection with resistant strains of Pseudomonas, Proteus, or staphylococci has been observed with lincosamides. Suppression of Bacteroides in the intestinal flora may be related to the prohferation of C. difficile, which is important in causing pseudomembranous colitis. Excessive growth of Candida on the skin occurred when lincomycin was applied topically (6). 

The tetracyclines administered orally or parenterally may lead to the development of superinfections caused by strains of bacteria or fungi resistant to these agents. Pseudomembranous colitis due to overgrowth of toxin-producing C. difficile presents with severe diarrhea, fever, and stools containing mucous membrane neutrophils. Discontinuation of the drug, combined with the oral administration of metronidazole or vancomycin, usually is curative. 

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