C diff infection and colitis

Question 1

CDAD stands for

Answer 1

c diff associated diarrhea

Question 2

What antibiotic provides low risk for CDAD?

Answer 2

bactrim

Question 3

what antibiotics are associated with CDAD?

Answer 3

broad spectrum abx like amoxicillin-clavulanic acid. Usually meant for respiratory infections.

Question 4

Treatment of C diff infection depends on how many episodes and complications.

Answer 4

True

Question 5

treatment of C diff with initial episode

Answer 5

PO vancomycin 125 mg qid for 10-14 days or fidaxomicin

Question 6

Treatment of recurrent C diff as a first reoccurrence

Answer 6

vancomycin PO in a prolonged taper course (2-8 weeks) OR fidaxomicin (for 10 days) if vancomycin was used as initial treatment episode

Question 7

Tx of recurrence of C diff and this has been multiple reoccurrances

Answer 7

vancomycin PO followed by rifaximin (or above regimens) fecal microbiota transplant

Question 8

fulminant C diff treatment

Answer 8

metronidazole IV PLUS high dose vancomycin PO or (per rectum if ileus is present) surgical evaluation

Question 9

what defines fulminant c diff infection

Answer 9

hypotension, shock, ileus, megacolon

Question 10

first line treatment of severe CDI infection without fulminant changes

Answer 10

oral vancomycin

Question 11

criteria for severe CDI

Answer 11

WBC>15K Serum Cr>1.5 or double baseline other: meets either and no signs of hypotension, shock, ilieus or megacolon

Question 12

serology chat for c diff testing

Answer 12

Question 13

Clinical manifestations of c diff colitis

Answer 13

Question 14

when after having antibiotics do pts start to have c diff infection? (average)

Answer 14

5-10 days but can be delayed up to 8 weeks.

Question 15

what separates out C diff from Shigella presentation?

Answer 15

C diff infection continues and no bloody mucoid diarrhea.

Shigella (endotoxin producing) has bloody mucoid diarrhea, fever, and abdominal pain that resolves spontaneously.

Question 16

entamoeba histolytica infections presentation

Answer 16

majority (90%) are asymptomatic

symptomatic pts will have bloody diarrhea and abdominal pain and these symptoms are subacute 1-3 weeks.

Question 17

what test is used for diagnosing C diff?

Answer 17

NAAT - polymerase PCR for C diff due to improved sensitivity over the more common enzyme immunoassay that is typically used.

PCR allows for use of single sample and provides rapid results.

Don’t use culture of toxin A = doesn’t take into acount toxin B so less sensitivity

We don’t use stool culture - time consuming and delays diagnosis

stool cytotoxin enzyme immunosassay is about 60-80% so not as effective.