Porco F V, Visconte E B
Department of Internal Medicine, Lutheran Medical Center, Brooklyn, NY 11220, USA.
Ann Pharmacother. 1995 Nov;29(11):1122-3. doi: 10.1177/106002809502901110.
To describe an immunocompromised patient (without AIDS) with nosocomial infectious diarrhea caused by Pseudomonas aeruginosa. Oral ciprofloxacin therapy proved to be effective.
An 80-year-old woman with type II diabetes mellitus and hypertension developed progressive renal insufficiency, was hospitalized because of uremia, and underwent hemodialysis. When the patient developed hematochezia, Duke's C sigmoid colon cancer was detected and successfully resected. She received broad-spectrum antibiotics in the perioperative period. The patient then developed profuse diarrhea associated with abdominal cramping, a low-grade fever, prostration, and headache. The patient then started to received vancomycin 500 mg po qid empirically. Four days later, the diarrhea continued unabated, the Clostridium difficile titer was negative, and the vancomycin therapy was stopped. However, the stool culture was positive for heavy growth of P. aeruginosa sensitive to ciprofloxacin. The patient then began to receive ciprofloxacin 500 mg po bid. Within 3 days the diarrhea stopped. Oral ciprofloxacin therapy was continued for 10 days and the patient remained free of symptoms with formed stools thereafter.
Diarrhea following the use of broad-spectrum antibiotics implicates pseudomembranous colitis as the cause. The patient did not respond to oral vancomycin therapy and had a negative stool assay for C. difficile toxin. This patient was believed to have Pseudomonas enteritis, which was confirmed by 2 positive stool cultures. The administration of oral ciprofloxacin therapy stopped her diarrhea with a rapid resolution of symptoms.
P. aeruginosa as a cause of infectious diarrhea is unusual. When it occurs, it usually represents a nosocomial infection in an immunocompromised host. This report illustrates that oral ciprofloxacin therapy is effective for Pseudomonas enteritis, with rapid resolution of symptoms.
描述一名免疫功能低下患者（无艾滋病）发生的由铜绿假单胞菌引起的医院感染性腹泻。口服环丙沙星治疗被证明有效。
一名80岁患有II型糖尿病和高血压的女性出现进行性肾功能不全，因尿毒症住院并接受血液透析。当患者出现便血时，检测出杜克C期乙状结肠癌并成功切除。她在围手术期接受了广谱抗生素治疗。随后患者出现大量腹泻，伴有腹部绞痛、低热、虚脱和头痛。患者随后开始经验性口服万古霉素500毫克，每日4次。4天后，腹泻持续未缓解，艰难梭菌滴度为阴性，万古霉素治疗停止。然而，粪便培养显示对环丙沙星敏感的铜绿假单胞菌大量生长呈阳性。患者随后开始口服环丙沙星500毫克，每日2次。3天内腹泻停止。口服环丙沙星治疗持续10天，此后患者一直无症状，大便成形。
使用广谱抗生素后出现腹泻提示伪膜性结肠炎为病因。该患者对口服万古霉素治疗无反应，粪便艰难梭菌毒素检测为阴性。该患者被认为患有铜绿假单胞菌肠炎，两次粪便培养阳性证实了这一点。口服环丙沙星治疗使她的腹泻停止，症状迅速缓解。
铜绿假单胞菌作为感染性腹泻的病因并不常见。当发生时，它通常代表免疫功能低下宿主的医院感染。本报告表明口服环丙沙星治疗对铜绿假单胞菌肠炎有效，症状可迅速缓解。
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