C. Diff

Question 1

C. diff:

Gram?
Where does it reside?

What usually causes infections and why?

Answer 1

Gram positive

GUT

Broad Spec Antibiotics

Usual balance within the bowel is disturbed
Allows growth of C. Diff
C. Diff produces a toxin at high quantities

Question 2

Transmission:

How is it usually transmitted?

Why is it so common?

Answer 2

Spores in healthcare setting

Spores remain viable in environment for long periods to time

Question 3

C. Diff risk factors:

What increases the risk?

Answer 3

Broad spec ABs

PPI’s for some reason
Increasing age
Hospitalisation
IBD

Question 4

Clinical Disease:

What 3 types of complications can occur in?

Complications occur due to toxins damaging the lining of the colon

Other complications:

• Dehydration
• AKI
• Electrolyte Imbalance

Answer 4

Pseudomembranous colitis
Toxic megacolon
Perforation

Question 5

How is it diagnosed?

Treatment:

Antibiotics:

• Used in mild-moderate disease?
• Used in severe/recurrent disease?

What can be to introduce new bacteria into the gut flora?

Answer 5

Stool sample - PCR/Toxin

Metronidazole (PO/IV)

Vancomycin (PO ONLY)

Faecal transplant in recurrent disease

Question 6

C. Diff Diagnosis:

What does C.diff carrier mean?

What means they have C. Diff induced disease?

Answer 6

C. diff carrier but no toxin detected

C. diff carrier and toxin present

Question 7

Prevention:

What type of AB treatment can be tried to reduce the risk?

What meds should be reviewed?

Answer 7

Antimicrobial stewardship - use the most narrow spec AB if possible

PPIs/H2 - they increase risk