129 - Clostridium difficile Infection, Including Pseudomembranous Colitis

Question 1

CD (Clostridium difficile) is an obligatory __ bacteria

Answer 1

anaerobic

Question 2

Which Abx increase the risk for CDI?

Answer 2

ampicillin
clindamycin
cephalosporines
fluoroquinolones

Question 3

The rate of CD colonization raises in relation to the __ of the hospitalization. In _% of patients admitted > _ weeks

Answer 3

duration
20
2

Question 4

CD is more common in __, __ > __

Answer 4

Caucasian
women
65

Question 5

Newborns are frequently __ __ of CD

Answer 5

asymptomatic

carriers

Question 6

Risk factors for CD: 6

Answer 6

old age
severe basic disease
GI surgery
rectal thermometer
enteral feeding
antacid treatment

Question 7

CD spores survive the stomach’s __, grow in the __ and settle in the __

Answer 7

acid
small bowel
lower GI

Question 8

Which toxins does CD produce?3

Answer 8

A- enterotoxin
B- cytotoxin
C- binary toxin, linked with C perfringens

Question 9

Which toxin is most violent?

Answer 9

B

Question 10

PMC=__

Answer 10

Pseudomembranous colitis

Question 11

In CDI usually all of the __ is involved by _% of patients have __ sparing

Answer 11

colon
10
rectal

Question 12

CD colonization __ the risk for CDI

Answer 12

reduce

Question 13

What are the 3 events necessary for CDI to develope?

Answer 13

exposure to antimicrobial
exposure to toxigenic CD
insufficient host response

Question 14

What is the collective name for the endemic CD strain?

Answer 14

NAP1/BI/027

Question 15

What are the characteristics of the NAP1/BI/027 strain? 3

Answer 15

1- X16-23 more toxins A and B
2- binary toxin CDT
3- resistant to most fluoroquinolones

Question 16

What are the clinical sings of CD?

Answer 16

diarrhea (no blood usually) with distinct smell
fever
abdominal pain
leukocytosis

Question 17

What are the 2 criteria necessary to diagnose CDI?

Answer 17

diarrhea (>=3 a day for >= 2 days) without any other reason

presence of toxin A/B in feces (PCR/culture) or pseudomembrane in the colon

Question 18

Before starting CDI treatment stop any __ treatment, if possible. _% of cases can resolve w/o __ treatment.

Answer 18

antimicrobial
23
Abx

Question 19

What is the treatment for mild to moderate initial CDI episode?

Answer 19

vancomycin / fidaxomicin / metronidazole PO

Question 20

__ is not as good as the other Abx in treating CDI, and should only be used when the others are unavailable

Answer 20

metronidazole

Question 21

What is the treatment for severe initial CDI episode?

Answer 21

vancomycin / fidaxomicin PO

Question 22

When do we consider treatment failure?

Answer 22

at least 6 days

Question 23

What is the treatment for initial fulminant CDI episode?

How long should the treatment be?

Answer 23

vancomycin PO + rectal vancomycin in normal saline enema
or
colectomy

> 2 weeks, depending on the response

Question 24

What is the definition of severe CDI?

Answer 24

leukocytosis >15K + Cr >= X1.5 the premorbid value

Question 25

What is the definition of fulminant CDI?

Answer 25

severe CDI + hypotension/shock/ileus/toxic megacolon

Question 26

What is the treatment for first recurrence of CDI episode?

Answer 26

oral vancomycin
or
fidaxomicin

Question 27

What is the treatment for multiple recurrence of CDI episode?

Answer 27

oral vancomycin 
or
vancomycin -> rifaximin
or
fidaxomicin 
or
fecal microbiota transplantation

Question 28

Fidaxomicin is better in preventing __ CDI

Answer 28

recurrent

Question 29

The treatment should last for at least _ days

Answer 29

10

Question 30

Prevent transition of CD with: 5

Answer 30

gloves
eliminating infected thermometer
bleach contaminated rooms
hands hygiene - wash rather than just use alcohol
avoid certain Abx if the patient is infected