C Diff Flashcards
1
Q
C. Difficile
A
- Gram “+” spore-forming anaerobe bacillus
- Produces toxins that mediates diarrhea and colitis
- Transmitted fecal-oral route
2
Q
Pathogenesis
A
- Broad-spectrum antibiotic therapy
- Causes disruption in colonic flora
- C.diff colonization and proliferation
- Releases of toxins A, B and binary toxin CDT
- Causes damage to colonic mucosa
3
Q
Main Abx Offenders for C. Diff
A
- Clindamycin
- Cephalosporin
- Fluoroquinolones
4
Q
C. Diff Presentation
A
- Fever
- Abdominal pain
- Leukocytosis
- Watery and perfuse diarrhea
- Can progress to life-threatening toxic megacolon (higher risk in older populations)
5
Q
C. Diff Risk Factors
A
- Antibiotic use
- Elderly patients
- Increased duration of hospitalization
- Chemotherapy
- GI Surgery
- Nasogastric tubes
- Laxative use
- Alteration of gut pH
- Immunosupression
6
Q
C. Diff Diagnosis
A
- > =3 unformed stools in 24 hours
- Tests: Stool culture, stool enzyme assay, NAAT/PCR
- Do NOT test unless asymptomatic
7
Q
Enhancing Sensitivity/Specificity of Tests
A
- Uses 2-step EIA
- Toxin A/B
- Glutamate dehydrogenase
- Treat if BOTH tests are positive or perform NAAT/PCR if contradictory
8
Q
C. Diff Management
A
- D/C offending agents
- Fluid/electrolyte replacement
- Avoid antimotility agents
- Infection control: hand washing, contact precautions, chlorine-containing cleaners or other sporicidal agents
9
Q
Non-Severe C. Diff Criteria/Treatment
A
Criteria
-WBC =< 15 x 10^3/mm3
AND
-SCr =< 1.5 mg/dL
Treatment
-Vanco x 10 days
OR
-FDX x 10 days
Alternative
Metro x 10 days
10
Q
Severe C. Diff Criteria/Treatment
A
Criteria
-WBC >= 15 x 10^3/mm3
OR
-SCr >= 1.5 mg/dL
Treatment
-Vanco x 10 days
OR
-FDX x 10 days
11
Q
Fulminant C. Diff Criteria/Treatment
A
Criteria
- Hypotension or shock
- Ileus (if complete, may require rectal instillation of vanco)
- Toxic megacolon
- Perforation
Treatment
-Vanco + Metro
Surgery consult recommended
12
Q
1st C. Diff Recurrence Treatment
A
- If Vanco used first, use FDX x 10 days
- If Vanco or FDX used first, use a tapered Vanco dosing for extended period
- If Metro used first, use Vanco for 10 days
13
Q
2nd C. Diff Recurrence Treatment
A
-Vanco tapered/pulsed regimen OR -Vanco x 10 days followed by rifaximin x 20 days OR -FDX x 10 days OR -Fecal microbiota transplantation
14
Q
FMT
A
- Fecal microbiota transplantation
- Should use antibiotics over FMT for 1st/2nd recurrence and save for 3rd recurrence
15
Q
Bezlotoxumab
A
- Human monoclonal antibody that binds to CD TcdB
- Used in combo with another active agent
- Decreases recurrence rates
