C diff

Question 1

Q: What causes Clostridioides difficile infection (CDI)?

Answer 1

A: CDI is caused by the organism Clostridioides difficile, typically through ingestion of spores via the fecal-oral route.

Question 2

Q: What factors can disrupt the GI flora, allowing C. difficile to overgrow?

Answer 2

A: Recent antibiotic use, proton pump inhibitors, and hospitalization.

Question 3

Q: Which toxins are produced by C. difficile and what condition do they cause?

Answer 3

A: Toxins A and B, which cause pseudomembranous colitis.

Question 4

Q: How can CDI present in patients?

Answer 4

A: Ranging from non-severe disease to severe or fulminant infection.

Question 5

Q: What is the first step if you suspect CDI in a patient?

Answer 5

A: Perform an ABCDE assessment to determine if the patient is unstable or stable.

Question 6

Q: How should you stabilize an unstable patient with suspected CDI?

Answer 6

A: Stabilize airway, breathing, and circulation; obtain IV access; resuscitate with IV fluids; and intubate if necessary.

Question 7

Q: What are common symptoms and history findings in CDI?

Answer 7

A: Watery diarrhea (often >3 loose stools in 24 hours), lower abdominal pain, fever, lethargy, confusion, and recent antibiotic use.

Question 8

Q: What might physical examination reveal in a patient with CDI?

Answer 8

A: Abdominal distention and tenderness, decreased bowel sounds, hypotension, and possibly altered mental status or shock.

Question 9

Q: What lab findings are typical in CDI?

Answer 9

A: Elevated WBC count, serum creatinine, and lactic acid.

Question 10

Q: What precautions should be taken if CDI is suspected?

Answer 10

A: Initiate contact precautions, discontinue inciting antibiotics if possible, and wash hands with soap and water.

Question 11

Q: What tests are used to diagnose CDI?

Answer 11

A: Glutamate dehydrogenase antigen test and C. difficile toxins A and B; if inconclusive, use a nucleic acid amplification test (NAAT).

Question 12

Q: How is fulminant CDI treated?

Answer 12

A: Supportive care with IV fluids and electrolyte replacement, bowel rest, total parenteral nutrition (TPN), nasogastric tube (NGT) decompression, and antibiotics (oral/nasogastric vancomycin plus IV metronidazole).

Question 13

Q: Why is IV metronidazole preferred over oral in fulminant CDI?

Answer 13

A: Fulminant CDI may involve ileus, preventing enough oral metronidazole from reaching the colon.

Question 14

Q: Why is oral vancomycin effective for all severities of CDI?

Answer 14

A: It reaches the colon without being absorbed.

Question 15

Q: What is the purpose of a fecal microbiota transplant in CDI?

Answer 15

A: To replenish healthy microbiota, protecting against C. difficile infection.

Question 16

Q: What imaging is used to assess for CDI complications, and what should be suspected if dilation or free air is found?

Answer 16

A: CT scan of the abdomen and pelvis; suspect toxic megacolon or perforation if dilation or free air is present.

Question 17

Q: How are stable patients with suspected CDI managed?

Answer 17

A: Obtain history and physical exam, initiate contact precautions, discontinue inciting antibiotics, and perform CDI testing.

Question 18

Q: How is non-severe CDI treated?

Answer 18

A: Supportive care with IV fluids, electrolyte replacement, a low-residue diet, and antibiotics (preferably fidaxomicin or vancomycin).

Question 19

Q: What lab findings indicate severe CDI?

Answer 19

A: WBC count of 15000 cells/ml or greater, or serum creatinine of 1.5 mg/dl or greater.

Question 20

Q: How is severe CDI treated?

Answer 20

A: IV fluids, electrolytes, antibiotics (fidaxomicin or vancomycin), bowel rest, TPN, and NGT decompression if needed.

Question 21

Q: How should recurrent CDI be managed?

Answer 21

A: Treat with antibiotics (fidaxomicin or vancomycin), consider adding bezlotoxumab for second recurrence, and consider fecal microbiota transplant for third or higher recurrence.

Question 22

Q: Why should alcohol-based sanitizers be avoided in CDI?

Answer 22

A: C. difficile spores are extremely resistant to alcohol; use soap and water instead.