C Difficile

Question 1

What type of bacteria is clostridioides difficile?

Answer 1

• A gram positive positive ,
  An anaerobic bacteria where the presence of oxygen is inhibitory to its growth.

Spore forming bacillus bacteria which is responsible for the development of antibiotics - associated diorreah and colitis.

Question 2

What is the mechanism of action of C. difficile ?

Answer 2

It produces two important types of toxins A and B

Toxin A is an entertoxin that causes excessive fluid secretion but also stimulates an inflammatory response and has some effect on damaging cell structure.

Toxin B is a cytotoxic and damages protein synthesis and cell structure.

Question 3

What is the mechanism of transmission of C. difficile ?

Answer 3

C. difficile is able to form spores. The spores are resistant to heat , acid and antibiotics and sruvuve for several months. The spores can be transferred to patients via the hands of healthcare personnel.

AND faecal oral route.

Question 4

How can antibiotic exposure result in C. difficile infections ?

Answer 4

The primary risk factor for Cdifficile is previous expire to antibiotics. The normal gut flora is in competition with eachother - however antibiotics alter and suppress the normal growth of flora which allows proliferation of C. difficile and toxin production.

Question 5

What antibiotics are more likely to. Cause C. difficile colitis ?

Answer 5

Cephalosporins

Fluroquinolones

Amoxicillin/ ampicillin

Clindamycin

Question 6

What are clinical features of C. difficile infection ?

Answer 6

1. MILD/MODERATE : Diarrhoea , presence of mucus or blood in stool. Fever , abdnrominal cramping , discomfort and pain.

SEVERE : leukocytosis , elevated serum creatinine levels ,

SEVERE / COMPLICATED : hypotension , sepsis , loss of bowl motility ,

Question 7

How to diagnose C. difficile ?

Answer 7

STOOL SAMPLE

1. Enzyme immunoassays which help to identify enzymes produced by bacteria : eg glutamate dehydrogenase.
2. Enzyme immunoassays can also help to detect toxins A and B

3.

Question 8

How to treat Cdifficile infection ?

Answer 8

MILD TO MODERATE : metronidazole ( oral protein IV) or vancomycin for 10 days. It is a broad spectrum antibiotic used to treat anaerobic bacteria. It kills the bacteria but not the spores , thus terminates the infection it leaves patient susceptible to recurrences.

SEVERE : vancomycin is considered to produce faster symptom resolution. This is excellent against activity of C. difficile. It kills the organism by inhibiting cell W wall synthesis. Only effective when giving enterally.

Question 9

What are the steps to prevent spread of C. difficile?

Answer 9

1. USE OF ANTIMICROBIAL AGENTS such as washing with soap , water etc .
2. Wear disposable gloves and gowns when treating patients with C. difficile. The use of alcohol is not effective in killing spores - soap and water more effective.
3. Isolate patients if positive.