C. DIfficile

Question 1

what are the risk factors for c diff infection?

Answer 1

history of recent (<3m) or current abx use
prolongued recent hospital stay
use of ppi/ h2 antagonists
increasing age especially > 65y
surgical procedure (in particular bowel procedures)
immunosuppression

Question 2

what 5 things should you do if you suspect c diff?

Answer 2

send stool for c diff testing 
inform infection control 
isolate patient in single room 
review ppi and stop laxatives/ abx if possible 
hand hygiene gloves and apron

Question 3

what are the severity markers of c diff?

Answer 3

T>38.5
ileus, colonic dilation >6cm on AXR, toxic megacolon, pseudomembrabous colitis
WBC >15
acute rising serum creatinine >1.5x baseline
persisting CDI (after 2 abx and pos stool)

Question 4

what do you do if the patient has non severe c diff?

Answer 4

oral metronidazole 10 days
rehydrate
if no improvement after 5 days or worsens at any time switch to oral vanc for 10 days

Question 5

what do you do if that patient has severe c diff?

Answer 5

oral vancomycin 10 days
if oral route not available give via ng tube
rehydrate
refer to ID if not responding

Question 6

when should a surgical team be called with regards to C diff?

Answer 6

ICU admission 
hypotension with or without vasopressors 
ileus or significant abdo distension 
mental status changes 
WBC>35 or <2 
end organ failure

Question 7

in severe c diff, if ileus detected or NG tube not available treat with

Answer 7

IV met and vanc (via NG or intracolonic) until ileus resolves

Question 8

if a patient needs gentamicin but has aki what do you give

Answer 8

aztreonam

Question 9

what is an alternative to vancomycin

Answer 9

daptomycin

Question 10

what type of bacteria is shigella

Answer 10

gram negative bacillus