C-Diff

Question 1

What is CDAD stand for?

Answer 1

Clostridioides difficile associated diarrhea

Question 2

What is CDAD

Answer 2

> = 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

Question 3

What are the biomarkers in the stool for C.Diff

Answer 3

Toxin A or B in the stool

Question 4

Who should be suspected of CDIFF?

Answer 4

patients with recent abx use within the previous 3 months

Question 5

What are the clinical manifestations?

Answer 5

Diarrhea (almost never grossly bloody_
- Distinct odour

Fever
Abdominal pain
Leukocytosis
May present with mild diarrhea to lfie threateniing megacolon

Question 6

What is step 1 pathogenesis of Cdiff?

Answer 6

Exposure to antimicrobrial agents establishes susceptibility to CDI through disrruption of normal colonic microbiota

Question 7

What is step 2 pathogenesis of CDIFF?

Answer 7

Exposure ot toxigenic C-Diff

Question 8

What is step 3 pathogenesis of C-Diff

Answer 8

Virulent strain or high risk antibiotic or inadequate host immune resposne

Question 9

Where is C-Diff mostly acquired?

Answer 9

Hospital or nursing homes

Question 10

What is toxic megacolin?

Answer 10

Toxic inflamed colon, sometimes this may warrant the removal of the colon

Question 11

How is C-Diff really caused?

Answer 11

Antibiotic caused infection general which is disrupted microflora

Question 12

What is the C-Diff Organis?

Answer 12

Gram positive
Spore forming
Anaerobic bacillus
Causees toxin mediated disease

Question 13

What is the new name for C-Diff

Answer 13

Clostridiodes Difficile

Question 14

What antibiotics can cause CDI?

Answer 14

All antibiotics technically and including those used to treat it

Question 15

What are the high risk antibiotics that can cause CDI?

Answer 15

Clindamycin fluoroquinolones, cephalosproins (3rd and 4th gen) ampicillin carbapenems

Question 16

What are the lowest risk antibiotics for causing CDI?

Answer 16

Penicillin, macrolides, tetracycline, TMP/SMX, aminoglycosides

Question 17

Risk of CDI continues untill?

Answer 17

3 months past therapy

Question 18

What are the risk factors of C-Diff

Answer 18

Question 19

What is the recurrences of C-Diff?

Answer 19

15-30% for first recurrence

Question 20

What may the relapse be?

Answer 20

Either same strain or new infection

Question 21

Which C-Diff strains produce the greatest amount of toxins?

Answer 21

NAP1/B1/027

Question 22

The difference of strains does not _____

Answer 22

Change the therapy choice and management

Question 23

What is the management for C-Diff?

Answer 23

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

Question 24

What are the severe disease category?

Answer 24

Leukocyte >15 000 cell/uL or SCr >1.5 baseline

Question 25

What are the drugs that should be avoided in C-Diff management?

Answer 25

Diphenoxylate, atropine, loperamide

Question 26

What is the first line therapy for C-Diff infection?

Answer 26

Vancomycin 125mg PO QID for 10-14 days

Question 27

What are the alternative therapies for C-Diff (Mild to moderate_

Answer 27

Question 28

What are the drug treatment initial episode for severe uncomplicated (In cases of hypoalbuminemia)

Answer 28

Question 29

What is treatment for intitial episode severe complicated C-Diff?

Answer 29

Question 30

On the second or subsequent recurrences what is the treatment?

Answer 30

Question 31

What are the 4 categories for second or sunseqeuent recurrences?

Answer 31

Vancomycin, Fecal microbiotica transplantation, MAB, surgery

Question 32

Which MAB should be used to target Toxin A?

Answer 32

Actoxumab

Question 33

Which MAB Should be used to target Toxin B

Answer 33

Bezlotoxumab