Scientific Poster Session I - Case Reports

Abstract

Case: A 58-year-old male with amyotrophic lateral sclerosis presented with pneumonia and gastrointestinal bleeding. Empiric cefepime was initiated, later escalated to meropenem and sulfamethoxazole/trimethoprim based on cultures. A percutaneous endoscopic gastrostomy (PEG) tube was placed on day 5. On day 9, the patient tested positive for toxigenic C. difficile, and fidaxomicin was administered via the tube. After clinical deterioration, treatment was switched to vancomycin via tube and IV metronidazole. VE was ordered due to persistent ileus; however, the patient refused VE after 3 days and could not tolerate tube therapy due to abdominal pain and ileus. FMT and surgical interventions were not recommended or were declined. With worsening hypotension and persistent ileus, IV tigecycline was initiated as salvage therapy on day 16, leading to improvement in vital signs and resolution of ileus.

Discussion: Tigecycline has demonstrated in vitro efficacy against CDI, but its clinical significance remains inconclusive. Some case reports and retrospective analyses suggest higher cure rates with tigecycline, while other studies indicate no significant benefits and potential increases in mortality. Both SHEA/IDSA and ESCMID guidelines provide weak, low-grade evidence for tigecycline in fulminant CDI refractory to standard therapy, citing retrospective studies and noting the lack of controlled trials. Treatment options are limited for patients unable or unwilling to take medications enterally or rectally.

Conclusion: With recurrent and refractory CDI cases becoming more common, tigecycline merits further study for fulminant CDI when standard therapy fails or VE/FMT are not viable options.

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