C.Diff,Biome-SS QL Flashcards
What is C. difficile?
Anaerobic gram-positive spore-forming bacillus. NAP1/B1/027 SPORES Survive Opportunistic. Suppressed in biome of diversity
How is C Diff spread? What is the challenge with its control?
Fecal oral route. The challenge is that it **creates spores, and these spores can survive outside of the colon for months, and are resistant to standard disinfection.
What is the leading cause of nosocomial diarrhea in the US?
C DIFF!
There is a particular strain of C Diff that has caused epidemics in our country. What strain is this and why is it so dangerous?
NAP1/BI/027 strain. This strain has a mutation in the gene that makes the toxin —> MORE toxin!
An infection with C Diff requires 2 factors. What are these 2 factors?
- Alteration of the normal microbiome —> vulnerable colon (usually d/t antibiotics). 2. Exposure to the organism (usually in a health care facility).
What antibiotics in particular are associated with C Diff infection?
ALL OF THEM.
After C Diff gets inside a vulnerable person, how/where does it act?
Once ingested, they germinate in the small bowel —> multiply in the colon and cause inflammation.
What is the biome “cloud?”
The organisms that a human emits in the space surrounding them. Humans emit 10^6 particles per hour.
Is it healthier to have a more or less diverse colonic biome?
MORE diverse!
Does the gut microbiota change over time or remain stable?
stable from age 3-5 years on. living in close quarters will increase a biome diversity.
What are the different clinical manifestations of the colonization of C Diff?
- Asymptomatic colonization (60-65%)
- Diarrhea, mild to severe
- Fulminant colitis/toxic megacolon (2-3%)
- Recurrent infection (20-30%)
How is C Diff diagnosed?
Toxin A&B EIA Enzyme Immunoassay through stool sample.
*Testing for the toxin produced by C Diff.
Can also do C Diff PCR to rule out C Diff. But a positive result only shows that the patient was exposed, not if they are currently infected.
How can we prevent C Diff infections?
- Antibiotic stewardship!!!! And recommend probiotics when prescribing
- Isolation of ill patients.
- Hand hygiene —> WASH hands with soap and water.
- Discontinue unnecessary PPIs (ruins defense mechanism of the body).
What is the treatment of C Diff?
- Stop offending antibiotics if possible.
- Vancomycin 125mg QID x10-14 days if severe disease or metronidazole intolerant. OR if complicated, PO vanco + IV metronidazole
What are the possible mechanisms of C Diff recurrence?
- Persistent spores
- Impaired host immune response
- Decreased biome diversity
- Reinfection from environment.
How should you treat a patient’s first recurrence of C Diff?
Re-treat with vancomycin x10-14 days.
How should you treat a patient’s 2nd recurrent C Diff?
Vancomycin pulse therapy: Vancomycin Q2D x4 days, then skin 2 days, continue for 4 more, skip 3 days, continue for 4 more, skip 4 days, continue for 4 more, then skip 5 days and continue for 4 more.
How should you treat a patient’s 3rd recurrent C Diff?
Fecal Microbiota Transplant: administration of feces from a human donor to another.
What are the different routes of administration of FMT? Do certain routes work better than others?
- Nasogastric or nasoduodenal tube 2. Retention enemas 3. Colonoscopy 4. Encapsulation NO! All routes are equally as effective.
Is there any risk that goes along with a fecal transplant?
YES! - Risk of infection - Risks related to administration, i.e. perforation, sedation-related complications, aspiration pneumonia or regurgitation of feces after nasoduodenal tube.
Is there any other pharmacologic treatment for recurrent C Diff infections that is not antibiotics?
Zinplava: monoclonal antibody against the toxin C Diff. **VERY expensive and only drops recurrence rate from 27-17%. Just came on to the market.
