C. Diff

Question 1

Definition of CDI

Answer 1

Unexplained diarrhea in form of 3 or more unformed stools in 24h in conjunction with positive stool test for C. diff toxins

Question 2

Pathogenesis of CDI

Answer 2

1. ) normal flora is disrupted
2. ) Outside source of C. diff comes in
3. ) Low [ ] of antibodies of toxin A
4. ) C diff diarrhea

If age > 65 or prior antibiotic treatment –> have increased risk of recurrence

Question 3

What are the symptoms of C. Diff Infection?

Answer 3

1. ) Watery, mucous like green, foul smelling diarrhea
2. ) Cramping abdominal pain
3. ) Leukocytosis (> 15,000)
   - In fulminant CDI
4. ) Hypoalbuminemia (< 2.5)
5. ) Increasing Scr with renal failure (in fulminant CDI)
6. ) toxic megacolon can develop

Question 4

Difference between C diff infection (CDI) and antibiotic-associated diarrhea (AAD)?

Answer 4

Results of positive stool toxin assay

Evidence of colitis

Question 5

Treatment for first episode of CDI?

Answer 5

Preferred: fidaxomicin

• Is expensive though
• Don’t have to give 1st

Vancomycin is good alternative

If fidaxomicin and Vancomycin is not available for non-severe CDI can give:
- metronidazole

Question 6

What is considered as non-severe CDI?

Answer 6

WBC 15,000 or less

SCr < 1.5

Question 7

What is the treatment for first reoccurrence of CDI?

Answer 7

Preferred: fidaxomicin

Alternative:

• vancomycin tapered/pulse therapy
• Vancomycin standard therapy (can considering giving standard if initially use metronidazole in 1st episode treatment)

Adjunctive treatment:
- Bezlotoxumab + standard care antibiotics (IF recurrence w/in last 6 months)

Question 8

What patients should we not give Bezlotoxumab with?

Answer 8

Patients with CHF

Question 9

Treatment for patients with 2nd recurrence or subsequent CDI ?

Answer 9

• Fidaxomicin
• Vancomycin tapered or pulsed
• Vancomycin standard dosing
• Fecal Microtobiota transplant (FMT)
• Adjunctive treatment:
• Bezlotoxumab + standard care of antibiotics (IF recurrence was in past 6 months)

Question 10

When should you use fecal microbiotia transplant? (FMT)

Answer 10

Recommend use after at least 2 recurrences (3 CDI episodes) before using FMT

Question 11

Treatment for fulminant (severe) CDI?

Answer 11

Vancomycin (higher dose)

If ileus is present –> add RECAL installation of PO/PR vancomycin + metronidazole

Question 12

What is considered as fulminant CDI?

Answer 12

• Hypotension or shock
• Ileus
• Toxic megacolon

Question 13

What is fecal microbiota transplantation (FMT)?

Answer 13

Giving fecal material from healthy donor to patient with CDI

Question 14

When is FMT used in CDI?

Answer 14

• After 2 recurrent episodes of mild to moderate CDI

Question 15

How to prevent CDI?

Answer 15

Good hand hygiene

Good environmental hygiene