13- GI infections Flashcards
types of liver abscesses
pyogenic, amoebic, hepatic abscesses
C difficile is what type of bacteria
gram positive spore forming bacillus, obligate anaerobe, part of normal gut flora in 1-3% of adults, and 70% of kids<12 months
some strains produce toxins A and B
how long do C diff spores last
> 5 months and are hard to destroy
what is the infective dose of C diff
<10 spores
transmission of c difficile
fecal oral route, person to person in hospitals, reservoirs are humans, environment
do all pts infected with c diff have symptoms
no some with be colonised with no symptoms instead of infected with symptomatic
most common antimicrobials predisposing to CDI
clindamycin ampicillin amoxillin cephalosporins fluoroquinolones -ALSO WITH PPI USE AND RENAL FAILURE
symptoms of c diff
watery diarrhea, loss of apetite, fever, nausea, abdominal pain and cramping
How can you test for C diff infection?
PCR on diarrheal stool
Testing asymptomatic pts is not indicated, testing for cure is not recommended
tx of c diff
metronidazole, standard regime, vancomycin
what is enteric fever
its a severe systemic illness with fever and abdominal pain; due to S enterica serotype typhi
chronic carriage of s typhi definition
is defined as excretion of s typhi in stool or urine>12 months after acute infection (occurs in women, pts with cholelithiasis)
Chronic carriage in the urine is rare and almost always
associated with an abnormality in the urinary tract (eg,
urolithiasis, prostatic hyperplasia) or concurrent bladder
infection with Schistosoma
The S. Typhi carrier state may be an independent risk factor for
carcinoma of the gallbladder as well as other cancers
For CDI surveillance you need to know the definition of a case of CDI, what is the definition
presence of diarrhea AND a stool test positive for C diff/ toxins A/B OR colonoscopic/histopathological findings of pseudomembranes
The best CDI preventative measure are
- decrease # of pts at risk (susceptible)
- decrease # of pts with CDI (reservoirs)
Antimicrobial stewardship reccomendations
Minimize the frequency and duration of antimicrobial
therapy
• Decrease the number of antimicrobial agents prescribed,
• Targeted antimicrobials should be based on the local
epidemiology and the C. difficile strains
• Restrict the use of cephalosporin and clindamycin
• Audit and feedback targeting broad-spectrum antibiotics
