CDAD

Question 2

Clostridioides difficile classification

Answer 2

Gram +ve, spore-forming anaerobic bacillus

Question 3

Role of ASP in reducing incidence of CDI:

Answer 3

Isolation: private rooms with dedicated toilet for CDI pts
Hand hygiene: PPE, handwashing with soap and water
Environmental cleaning: sporicidal agents
Antimicrobial stewardship: minimise freq and duration of high risk abx and no. of Abx
Restrictive use, prior approval , removal from pharmacy

Question 4

RF for CDI

Answer 4

Advanced age > 65yo
Multiple/severe comorbidities
Immunosuppresion
CDI Hx
GI surgery
Tube feeding
Prior hospitalisation (last 1y)
Duration of hospitalisation
Residence in nursing home/LT facilities
Use of Abx: clindamycin, 3rd/4th gen cephalosporins, fluoroquinolones
Use of gastric acid suppressive therapy (PPI)

Question 6

Sx of CDI

Answer 6

Watery diarrhoea (>3 loose stools in 24h)
Mild: diarrhoea, abdominal cramps
Moderate: fever, DN, malaise, abdominal cramps and distension, leukocytosis, hypovolemia
Severe : WBC>15x10^9/L, SCr >133umol/L(1.5mg/dL), fever diarrhea, diffused abdominal cramps and distention
Fulminant: hypotension/shock, ileus (no peristalsis/movement), megacolon(risk of perfusion)

Question 7

Diagnosis of CDI

Answer 7

Presence of Watery diarrhoea (>3 loose stools in 24h) or
Radiographic evidence of ileus or toxic megacolon
and
+ve stool test result for C. difficile or its toxins (for symptomatic pts only; DN repeat test <7d) or
Colonoscopy evidence of pseudomembranous colitis

Question 8

Abx for CDI

Answer 8

non-sev:
PO vancomycin 125mg QDS
Or
PO metronidazole 400mg TDS

Sev: WBC>15x109/L, SCr >133umol/L(1.5mg/dL)
PO vancomycin 125mg QDS

Fulminant: hypotension/shock, ileus, megacolon
IV metronidazole 500mg Q8H +
PO vancomycin 125mg QDS

Duration: 10d -14d if sx persist

Question 9

monitoring for CDI

Answer 9

Resolution in 10d, extend to 14d if unresolved
Consider escalation if poor response
discontinue >14d as no benefit