CDIFF Flashcards
C diff is
gram positive spore forming
H pylori is
gram negative
prevalence in healthy infants
> 50%
prevalence in hospital pts
20-40% more than 2 days
asymptomatic colonization rate
60-65%
6x higher risk in pts hospitalized with previous colinization
chances of developing toxic megacolon
2-3%
chances of recurrent infection
20-30%
what antibiotics have been associated with C diff
b. All antibiotics have been associated with CDI
how long can spores survive in an enviroment
e. Spores can survive in environment for days/months and are resistant to common hospital disinfectants.
CDI: Testing Methods
PCR (mostly done now) = STANDARD TESTING
also ELISA
and GDH (low specificity for both)
toxigenic culture but not widely available
what is ELISA looking for with cdiff
ii. ELISA í looks for antibodies against C. diff toxins
gold standard for testing
toxigenic culture
guideline reccomendations
Greater antibiotic stewardship - use less abx
Isolation (when available), cohorting when not (? increased recurrence rates)
Hand Hygiene / Contact Precautions
HAND SANTIZERS DON’T WORK FOR C. DIFF
if you prescribe anbx give probiotic
is screening recommended for cdiff in workers?
Neither recommends screening of asymptomatic patients or staff, or Rx of asymptomatic carriers.
current guideline for c diff treatment
Stop offending Abx if possible, avoid anti-peristaltics
Empiric Rx appropriate when high suspicion
Metronidazole 500mg TID x10-14d (mild/moderate) = FIRST LINE tx
when would you use vancomycin
severe disease, metronidazole intolerant, pregnant/breastfeeding, or failure to respond 5-7 days
Vancomycin 125mg QID x10-14d
what do you do for complicated disease tx
PO/PR vanco plus IV metro
when would you do surgery
that early operative intervention is beneficial in severe disease
When would someone be a surgical candidate
shock, pressors, renal failure, MS changes, lactate >5mmol/l, intubation
chance of reoccurrence
a. 20% after initial Rx
b. 40% after 1st recurrence
60%
i. People who recur keep recurring - largely d/t spores
why do we see such a high reoccurrence rate
i. ? Persistent spores
ii. ? Impaired host immune response (lower anti-toxin IgG antibody levels in patients with rCDI)
iii. Decreased biome diversity
iv. ? Reinfection from environment
what do you do for reoccurance
first time same regimen
taper/pulse regimen –> withdraw therapy, allow spores to germinate and then start therapy again
ACG explicitly recommends ‘consideration of FMT’ after third recurrence and after taper (SHEA silent)
f. Forget MORE abx… Fix the flora w/ FMT
what happens following the digestion of C diff
germinate in small bowle
multiply in the colon
cause inflammation and colitis
