CDIFF

Question 1

C diff is

Answer 1

gram positive spore forming

Question 2

H pylori is

Answer 2

gram negative

Question 3

prevalence in healthy infants

Answer 3

> 50%

Question 4

prevalence in hospital pts

Answer 4

20-40% more than 2 days

Question 5

asymptomatic colonization rate

Answer 5

60-65%

6x higher risk in pts hospitalized with previous colinization

Question 6

chances of developing toxic megacolon

Answer 6

2-3%

Question 7

chances of recurrent infection

Answer 7

20-30%

Question 8

what antibiotics have been associated with C diff

Answer 8

b. All antibiotics have been associated with CDI

Question 9

how long can spores survive in an enviroment

Answer 9

e. Spores can survive in environment for days/months and are resistant to common hospital disinfectants.

Question 10

CDI: Testing Methods

Answer 10

PCR (mostly done now) = STANDARD TESTING

also ELISA

and GDH (low specificity for both)

toxigenic culture but not widely available

Question 11

what is ELISA looking for with cdiff

Answer 11

ii. ELISA í looks for antibodies against C. diff toxins

Question 12

gold standard for testing

Answer 12

toxigenic culture

Question 13

guideline reccomendations

Answer 13

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

Question 14

is screening recommended for cdiff in workers?

Answer 14

Neither recommends screening of asymptomatic patients or staff, or Rx of asymptomatic carriers.

Question 15

current guideline for c diff treatment

Answer 15

Stop offending Abx if possible, avoid anti-peristaltics

Empiric Rx appropriate when high suspicion

Metronidazole 500mg TID x10-14d (mild/moderate) = FIRST LINE tx

Question 16

when would you use vancomycin

Answer 16

severe disease, metronidazole intolerant, pregnant/breastfeeding, or failure to respond 5-7 days

Vancomycin 125mg QID x10-14d

Question 17

what do you do for complicated disease tx

Answer 17

PO/PR vanco plus IV metro

Question 18

when would you do surgery

Answer 18

that early operative intervention is beneficial in severe disease

Question 19

When would someone be a surgical candidate

Answer 19

shock, pressors, renal failure, MS changes, lactate >5mmol/l, intubation

Question 20

chance of reoccurrence

Answer 20

a. 20% after initial Rx
b. 40% after 1st recurrence

60%
i. People who recur keep recurring - largely d/t spores

Question 21

why do we see such a high reoccurrence rate

Answer 21

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

Question 22

what do you do for reoccurance

Answer 22

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

Question 23

what happens following the digestion of C diff

Answer 23

germinate in small bowle
multiply in the colon

cause inflammation and colitis