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Therapeutics IV > C. diff - Block 2 > Flashcards

C. diff - Block 2 Flashcards

1
Q

Describe chracterisitcs of c diff?

A

Spore forming, toxin producing, G+ anaerobic bacteria

Colonizes in the colon -> ABX associated diarrhea and colitis
Transmission: fecal oral

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2
Q

Describe the pathology of C diff?

A
  1. Spores live on surface
  2. Spores are ingested and lays dormant in intestines
  3. Disruption of normal flora
  4. C diff produces toxins A and B -> damage to colon -> inflammation/tissue damage -> diarrhea
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3
Q

Ways you can prevent C diff?

A
  1. Soap and water handwashing
  2. Alcohol based hand sanitizers is NOT effective against spores
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4
Q

What are the precautions taken when encountering Cdiff?

A
  1. Clean hands with soap and water
  2. Wear gloves
  3. Wear gown
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5
Q

What common RF for C diff infection?

A
  1. ABX use
  2. Age
  3. Hospitalization and length of stay
  4. PPI
  5. Immunocompromised
  6. IBD
  7. GI surgery
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6
Q

What are the most common ABX that cause C diff?

A

3rd and 4th gen cephalosporins

Any ABX has a risk killing good bacteria

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7
Q

Sx of C diff?

A
  1. Diarrhea (soft and unformed, strong odor, 20+ movements)
  2. Ab pain
  3. N/V
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8
Q

Signs of C diff?

A

Leukocytosis >15000
Fever

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9
Q

Complications of C diff?

A
  1. Dehydration and electrolyte disturbances
  2. Pseudomembranous colitis
  3. Toxic megacolon
  4. Bowel perforation
  5. Death in 30 days
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10
Q

Diagnostic elements of target CDI population?

A
  1. Unexplained
  2. New onset
  3. ≥3 unformed stools in 24 hrs
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11
Q

What are the diagnostic lab assays of C diff?

A
  1. GDH antigen
  2. Toxins A and B
  3. NAAT
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12
Q

What are the tx goals for C diff?

A
  1. Alleviate GI sx
  2. Avoid complications from infection
  3. Minimize transmission
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13
Q

What are the non pharm recommendatiosn for c diff?

A
  1. Hand hygiene
  2. Use of gloves and gowns
  3. Isolation
  4. Contact precautions
  5. Avoid antidiarrheal agents and PPIs
  6. Antibiotic stewardship
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14
Q

Usage of probiotics for C diff tx?

A

Some reduction but insufficient data to use as a recommendation

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15
Q

Tx used for C diff?

A

Fidaxomicin
Vancomycin
Metronidazole
Rifaximin
Benzlotoxumab

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16
Q

Benefits of using fidaxomicin?

A

Post-ABX effect for 6-10 hr
Minimal systemic absorption

17
Q

CP of Vancomycin?

A

Increased GI sx
Poor systemic absorption

18
Q

Cp for Flagyl?

A

CNS effects -> well absorbed systemically
Superinfection risk
Rising resistance rates

19
Q

CI for Flagyl?

A
  1. Firsttrimester pregnancys
  2. Disulfiram within past 2 weeks
  3. Alcohol or propylene glycol within 3 days
20
Q

Why do we use Fidaxomicin over PO vanc?

A

Fewer recurrences of CDI

21
Q

Indications for Bezlotoxumab?

A

Zinplava (adjunct) is indicated >18 YO to reduce recurrence (secondary prevention) of CDI in patients recievign ABX tx and at high risk for recurrance:
* Hx of CDI
* ≥65 YO
* Immunocompromised
* Severe CDI (Zar ≥2)

22
Q

What are the components of Zar criteria?

A
  1. > 60YO
  2. Temp >38.3
  3. Albumin <2.5
  4. WBC >15,000
  5. Endoscopic evidence of pseudomembranous colitis
  6. ICU stay

Severe dx is ≥2

23
Q

ADR and Caution of Bezlotoxumab?

A

ADR: N, pyrexia, HA
Caution: CHF -> frequent exacerbations and more deaths than placebo

24
Q

What is the tx protocol for CDI?

A
  1. DC offending ABX agent asap
  2. Adminsiter fluid and electrolyte
  3. Start empiric ABX therapy
25
Q

What is the difference between non-severe and severe/fulminant?

A

Non: doesn’t meed criteria
S/F:
* WBC ≥15000 OR
* sCr >1.5

26
Q

Distinguish severe from fulminant?

A

Severe: doesn’t meet criteria
Fulminant:
* Hypotension/shock
* Ileus
* Toxic megacolon

27
Q

Tx for intial CDI episode (severe and non-severe)?

A

1st: Fidaxomycin BID x 10 days
Alt:
* Vancomycin PO x 10 days
* Metronidazole PO x 10 days (non-severe CDI and other agents are unavailable)

28
Q

Tx for intial CDI episode (fulminant)

A

1st: Vancomycin PO + Metronidazole IV
Ileus is present: Vanc retention enema

Vanc > fidaxomicin for fulminant

29
Q

Tx for first CDI recurrence?

A

1st: fidaxomicin PO
Alt:
* Vancomycin PO tapered and pulsed
* Vancomycin PO x 10 days (standard if metronidazole is used in 1st episode)

Adj: Bezlotoxumab IV w/ SOC ABX and episode is within 6 months (CHF caution)

30
Q

Tx for second or subsequent CDI recurrence?

A

1st: Fidaxomicin PO
Alt:
* Vanc PO tapered and pulsed
* Vanc PO x 10 days followed by rifaximin x 20days
* Fecal microbiota transplantation (at least 2 recurrences, but ABX should be tried first)

Adj: Bezlotoxumab IV w/ SOC ABX and episode is within 6 months (CHF caution)

Therapeutics IV (39 decks)

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