C. difficile

Question 1

Identify 4 features of C. difficile relating to its structure

Answer 1

Gram positive
Anaerobic
Spore forming
Bacillus

Question 2

What is the most common mechanim of infection with C. difficile

Where does this organism colonise

Answer 2

Fecal-oral, Spore transmission

Bowel

Question 3

Say 3 things about C. diff spores that allow it to survive for several months

Answer 3

Heat resistant
Acid resistant
Antibiotic resistant

Question 4

Describe the virulence of C. difficile

Is it invasive

Answer 4

Enzymes and toxins damage epithelial cells-> Fluid secretion, neutrophil adhesion, local inflammation

Not invasive

Question 5

Which 2 toxins are made by C. difficile, how do they work?

Answer 5

Toxin A: An enterotoxin, causes fluid secretion, inflammation, damages cell structure

Toxin B: Cytotoxin, damages protein synthesis and cell structure

Question 6

What are the 3 main risk factors for CDI (C. difficile infection)

Give 4 examples of the primary one

Answer 6

Antibiotic exposure;

• Cephalosporins
• Amoxicillin
• Clindamycin (Used for MRSA)
• Quinolones

Old age
Hospitalisation

Question 7

What are 4 symptoms of CDI (C. difficile infection)

How is it treated

Answer 7

Diarrhoea
Fever
Abdominal pain
Bowel dilation if severe

• Oral/ IV Metronidazole or Oral Vancomycin for 10 days

(Vancomycin if severe)

Question 8

If patient has suspected C. difficile infection, what are 2 important things to do

Answer 8

Isolate immediately

Use water and soap, NOT ALCOHOL, as alcohol doesn’t kill the spores

Question 9

Other than Vancomycin and Metronidazole, name 2 treatments for C. difficile infection (CDI)

Answer 9

• Fidaxomicin (used in America): Inhibits nucleic acid synthesis
• Faecal Micriobitoa Transplantation: Transfer of stool from healthy patient to CDI infected patient. (Reconstitutes normal colonic flora)