C. diff

Question 1

What is Clostridioides difficile?

Answer 1

A gram +ve anaerobic bacillus.

It is the most common healthcare associated pathogen.

It is part of the colonic flora in 2-5% of healthy adults and 20-40% of hospitalised adults.

The disease occurs when it converts to a vegetative state aka a growth with production of enterotoxins A and B.

This leads to colitis.

This typically happens when inhibition by competing colonic flora is lost due to antibiotics.

Question 2

Presentation of C. diff infection.

Answer 2

Watery diarrhoea

There is mild to fulminant colitis, ileus.

Can also cause toxic megacolon.

This should be considered in all diarrhoea when there is antibiotic use as well, especially if there is marked neutrophilia.

Question 3

Diagnosis of C. diff infection.

Answer 3

Stool sample with enzyme immunoassay + NAAT.

Immunoassay for glutamate dehydrogenase which is a common antigen. This immunoassay detects all strains of C. diff.

Detection of toxin distinguishes infection from carriage.

Imaging with AXR and CT abdo pelvis might be done.

Flexible sigmoidoscopy can be done as well, but should not be if there is a typical presentation.

Question 4

Non-pharma approach to C. diff infection.

Answer 4

SIGHT

Suspect

Isolate within 2h

Gloves and aprons

Hand wash with soap

Test immediately

Question 5

Management of mild/moderate C. diff.

Answer 5

Metronidazole PO

Question 6

Management of severe C. diff.

Answer 6

Severe means WCC >15x10^9/L or AKI or Colitis or temp >38.5C.

Give vancomycin PO or fidaxomicin

Question 7

Management of non-responding C. diff.

Answer 7

High dose vancomycin + IV metronidazol, fidaxomicin, IV immunoglobulin.

Question 8

Treatment of recurring C. diff infection.

Answer 8

Weaning vancomycin, fidaxomicin, faecal transplantation