C-Difficile Infection Post Colonoscopy Procedure

This case involves a patient who underwent a colonoscopy and the patient was sent for a follow-up elective surgery to remove several suspicious polyps. The surgery was uneventful but during the 3-5 day post operative period the patient became severely sick from an infected surgical wound. The patient was taken in for an exploratory procedure and it was determined that a C-difficile infection was responsible. The patient never recovered from his initial infection and died several weeks later.

Question(s) For Expert Witness

1. What would have been the appropriate antibiotic regimen before, during, and after surgery for this patient?

Expert Witness Response E-001698

According the to SCIP guidelines, the appropriate antibiotic for wound infection prevention is a cephalosporin along with metronidazole intravenously. Many surgeons also give an oral bowel prep the day before surgery, but this is not required. C. diff infections are rare, and can result in fulminant colitis, requiring a total colectomy in severe cases. It is very rare to see clostridium species infections when a patient has been given metronidazole.