129 - Clostridium difficile Infection, Including Pseudomembranous Colitis Flashcards
CD (Clostridium difficile) is an obligatory __ bacteria
anaerobic
Which Abx increase the risk for CDI?
ampicillin
clindamycin
cephalosporines
fluoroquinolones
The rate of CD colonization raises in relation to the __ of the hospitalization. In _% of patients admitted > _ weeks
duration
20
2
CD is more common in __, __ > __
Caucasian
women
65
Newborns are frequently __ __ of CD
asymptomatic
carriers
Risk factors for CD: 6
old age severe basic disease GI surgery rectal thermometer enteral feeding antacid treatment
CD spores survive the stomach’s __, grow in the __ and settle in the __
acid
small bowel
lower GI
Which toxins does CD produce?3
A- enterotoxin
B- cytotoxin
C- binary toxin, linked with C perfringens
Which toxin is most violent?
B
PMC=__
Pseudomembranous colitis
In CDI usually all of the __ is involved by _% of patients have __ sparing
colon
10
rectal
CD colonization __ the risk for CDI
reduce
What are the 3 events necessary for CDI to develope?
exposure to antimicrobial
exposure to toxigenic CD
insufficient host response
What is the collective name for the endemic CD strain?
NAP1/BI/027
What are the characteristics of the NAP1/BI/027 strain? 3
1- X16-23 more toxins A and B
2- binary toxin CDT
3- resistant to most fluoroquinolones
What are the clinical sings of CD?
diarrhea (no blood usually) with distinct smell
fever
abdominal pain
leukocytosis
What are the 2 criteria necessary to diagnose CDI?
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
Before starting CDI treatment stop any __ treatment, if possible. _% of cases can resolve w/o __ treatment.
antimicrobial
23
Abx
What is the treatment for mild to moderate initial CDI episode?
vancomycin / fidaxomicin / metronidazole PO
__ is not as good as the other Abx in treating CDI, and should only be used when the others are unavailable
metronidazole
What is the treatment for severe initial CDI episode?
vancomycin / fidaxomicin PO
When do we consider treatment failure?
at least 6 days
What is the treatment for initial fulminant CDI episode?
How long should the treatment be?
vancomycin PO + rectal vancomycin in normal saline enema
or
colectomy
> 2 weeks, depending on the response
What is the definition of severe CDI?
leukocytosis >15K + Cr >= X1.5 the premorbid value
What is the definition of fulminant CDI?
severe CDI + hypotension/shock/ileus/toxic megacolon
What is the treatment for first recurrence of CDI episode?
oral vancomycin
or
fidaxomicin
What is the treatment for multiple recurrence of CDI episode?
oral vancomycin or vancomycin -> rifaximin or fidaxomicin or fecal microbiota transplantation
Fidaxomicin is better in preventing __ CDI
recurrent
The treatment should last for at least _ days
10
Prevent transition of CD with: 5
gloves
eliminating infected thermometer
bleach contaminated rooms
hands hygiene - wash rather than just use alcohol
avoid certain Abx if the patient is infected
