C. diff

Question 1

how do you spell c. diff in full?

Answer 1

clostridium difficle

Question 2

what is clostridium difficile colitis?

Answer 2

an inflammation of the colon caused by an overgrowth of clostridium difficile usually post abx use

Question 3

what are some RF for clostridium difficile colitis?

Answer 3

top risk factor: recent abx use; more specifically clindamycin, fluoroquinolones, penicillins, and cephalosporins

other:
- recent GI surgery
- chemo w/ antimicrobial/immunosuppressive effects
- meds that decrease stomach acid
- older age, cirrhosis, IBD, enteral feeding, obesity, and chronic renal disease

Question 4

patho for clostridium difficile colitis

Answer 4

1. colonization by clostridium difficile typically does not produce symptoms (fecal-oral transmission)
2. some sort of event changes the microbiome of the GI tract
3. allows for the overgrowth of clostridium difficile ➔ c. diff infection
4. clostridium difficile releases toxins
5. toxins (A and B) result in inflammation of the GI tract and poor absorption
6. s/s
   - watery diarrhea and hypotension bc incease fluid into GI tract and decrease fluid reabsorption
   - bloody stool bc damaged colonocytes
   - abdo cramps vs inflam of visceral peritoneum
   - bowel perf or toxic megacolon bc inflammation and destruction ➔ large bowel dilation and muscle paralysis

Question 5

some s/s of clostridium difficile colitis

Answer 5

1. watery diarrhea, may be bloody
2. abdo pain/cramping
3. N/V
4. anorexia
5. low-grade fever

watch out for s/s of hypovolemic shock, toxic megacolon and perforated bowel

Question 6

how do you dx a clostridium difficile infection?

Answer 6

stool sample, send for toxin analysis (toxin A and B)

would also do other stool cultures + O&P to r/o other ddx

Question 7

what other lab work and imaging would be imp for someone with clostridium difficile collitis?

Answer 7

1. CBC with diff
2. electrolytes bc dehydration
3. creatinine and urea
4. VBG/ABG if unstable
5. abdo u/s or XR to look for toxic megacolon or perforation

Question 8

how would you tx clostridium difficile collitis?

Answer 8

1. abx – vancomycin PO; if severe could add metronidazole
2. fluids to rehydrate
3. contact precautions (fecal-oral transmission) and isolation
4. monitor for cx like perforated bowel or toxic megacolon that may need surgical consult later
5. if clostridium difficile becomes recurrent; consider fecal transplant or prolonged, tapered, and pulsed vancomycin regimen