C-Diff Flashcards
What is CDAD stand for?
Clostridioides difficile associated diarrhea
What is CDAD
> = 3 unformed stools per 2 hour for >=2 days with no other recognized cause
Diarrhea will not occur in the presence of ileus
AND toxin A or B in the stool or toxin-in producing C.Diff in the stool
Or visualization of pseudomembranes in the colon via colonoscopy
What are the biomarkers in the stool for C.Diff
Toxin A or B in the stool
Who should be suspected of CDIFF?
patients with recent abx use within the previous 3 months
What are the clinical manifestations?
Diarrhea (almost never grossly bloody_
- Distinct odour
Fever
Abdominal pain
Leukocytosis
May present with mild diarrhea to lfie threateniing megacolon
What is step 1 pathogenesis of Cdiff?
Exposure to antimicrobrial agents establishes susceptibility to CDI through disrruption of normal colonic microbiota
What is step 2 pathogenesis of CDIFF?
Exposure ot toxigenic C-Diff
What is step 3 pathogenesis of C-Diff
Virulent strain or high risk antibiotic or inadequate host immune resposne
Where is C-Diff mostly acquired?
Hospital or nursing homes
What is toxic megacolin?
Toxic inflamed colon, sometimes this may warrant the removal of the colon
How is C-Diff really caused?
Antibiotic caused infection general which is disrupted microflora
What is the C-Diff Organis?
Gram positive
Spore forming
Anaerobic bacillus
Causees toxin mediated disease
What is the new name for C-Diff
Clostridiodes Difficile
What antibiotics can cause CDI?
All antibiotics technically and including those used to treat it
What are the high risk antibiotics that can cause CDI?
Clindamycin fluoroquinolones, cephalosproins (3rd and 4th gen) ampicillin carbapenems
What are the lowest risk antibiotics for causing CDI?
Penicillin, macrolides, tetracycline, TMP/SMX, aminoglycosides
Risk of CDI continues untill?
3 months past therapy
What are the risk factors of C-Diff
What is the recurrences of C-Diff?
15-30% for first recurrence
What may the relapse be?
Either same strain or new infection
Which C-Diff strains produce the greatest amount of toxins?
NAP1/B1/027
The difference of strains does not _____
Change the therapy choice and management
What is the management for C-Diff?
Stop antibiotic (Clinical judgement up to prescriber)
Fluid and electrolyte
Avoid drugs that inhibit peristalsis such as diphenoxylate/atropine and loperamide
Categorize and mild vs severe and uncomplicated vs complicated
What are the severe disease category?
Leukocyte >15 000 cell/uL or SCr >1.5 baseline
What are the drugs that should be avoided in C-Diff management?
Diphenoxylate, atropine, loperamide
What is the first line therapy for C-Diff infection?
Vancomycin 125mg PO QID for 10-14 days
What are the alternative therapies for C-Diff (Mild to moderate_
What are the drug treatment initial episode for severe uncomplicated (In cases of hypoalbuminemia)
What is treatment for intitial episode severe complicated C-Diff?
On the second or subsequent recurrences what is the treatment?
What are the 4 categories for second or sunseqeuent recurrences?
Vancomycin, Fecal microbiotica transplantation, MAB, surgery
Which MAB should be used to target Toxin A?
Actoxumab
Which MAB Should be used to target Toxin B
Bezlotoxumab
