C.DIFFICILE

Question 1

Describe the microbiology of c.difficile?

Answer 1

gram +ve

anaerobic

Question 2

What site does c.difficile infect?

Answer 2

intestines

Question 3

How is C.difficile acquired?

Answer 3

cross infection or toxigenic strain

Question 4

Who is most at risk of c.difficile?

Answer 4

elderly with underlying disease

Question 5

What are the symptoms of C.difficile?

Answer 5

diarrhoea
severe illness
ulceration
colitis

Question 6

What allows c.difficile development?

Answer 6

Disturbance of microbiota and normal flora in colon by antibiotics allows c difficile to multiply and produce toxin

Question 7

What does c.difficile produce that enables its survival in environment for a longer time?

Answer 7

spores

Question 8

How is C.difficile treated?

Answer 8

 Assess severity by WCC, abdominal pain and temp
 Stop precipitating antibiotics
 Stop anti-diarrhoeal agents
 Stop gastric acid suppressive agents
 Stop laxatives
 Assess fluid balance and ensure adequate hydration
 Assess nutritional status- contact dietician if needed
 Mild= oral metronidazole
 Severe= oral vancomycin

Question 9

How is C.difficile prevented?

Answer 9

	Wise use of antibiotics to reduce incidence
	Minimise exposure to 
1.	Fluoroquinolones
2.	Cephalosporins
3.	Clindamycin 
	Avoid prolonged courses
	Avoid multiple antibiotics
	Infection control and preventing spread 
	Isolation
	Handwashing

Question 10

What does broad spectrum antibiotics mean?

Answer 10

activity against both gram + and – bacteria

Question 11

What antibiotics precipitate C.difficile?

Answer 11

Cephalosporins
Ciprofloxacin- quinolones/fluoroquinolones
Clindamycin
Co-amoxiclav

Question 12

Why is alcohol gel or disinfection not effective against c/difficile?

Answer 12

C.difficile forms spores which survive for a long time in the environment
Alcohol in disinfection products is not effective against spore forming bacteria like C.difficile

Question 13

Why is IV vancomycin not appropriate in C.difficile?

Answer 13

IV vancomycin reaches high concs in systemic circulation not at the site of infection
It needs to reach colon so should be given orally