C.Difficile infection Flashcards

1
Q

About C.Difficile infection?

A

Clostridioides difficile is aGram positive rodoften encountered in hospital practice. It produces an exotoxin which causes intestinal damage leading to a syndrome called pseudomembranous colitis.

C. difficile develops when the normal gut flora are suppressed by broad-spectrum antibiotics.

Other than antibiotics, risk factors include:
- proton pump inhibitors

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2
Q

Leading cause of C diff?

A

2nd and 3rd generation cephalosporins

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3
Q

Clinical presentation?

A
  • diarrhoea
  • abdominal pain
  • araised white blood cell count (WCC)is characteristic
  • if severe toxic megacolon may develop
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4
Q

Life-threatening presentation?

A

hypotension

partial or complete ileus

toxic megacolon, or CT evidence of severe disease

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5
Q

Severe presentation?

A
  • High WCC (>15 x 10^9/L) or an acutely high creatinine (>50% above baseline)

or a temperature > 38.5

or evidence of a severe colitis (abdominal or radiological signs)

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6
Q

Moderate c diff infection?

A

high WCC (but less than 15 x 10^9/L)

typically 3-5 loose stools per day

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7
Q

Mild c diff infection?

A

normal WCC

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8
Q

Treatment of C diff infection? (first episode)

A

Current antibiotic therapy should be reviewed and antibiotics stopped if possible.

First episode of C. difficile infection

  • first-line therapy isoral vancomycinfor 10 days
  • second-line therapy:oral fidaxomicin
  • third-line therapy:oral vancomycin +/- IV metronidazole
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9
Q

treatment of a recurrent episode of C.diff?

A
  • recurrent infection occurs in around 20% of patients, increasing to 50% after their second episode
  • within 12 weeks of symptom resolution: oral fidaxomicin
  • after 12 weeks of symptom resolution: oral vancomycin OR fidaxomicin
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10
Q

treatment of life-threatening C.diff infection

A
  • oral vancomycin AND IV metronidazole
  • specialist advice - surgery may be considered
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11
Q

Other therapies for the treatment of C.diff infection?

A
  • bezlotoxumabis a monoclonal antibody which targetsC. difficiletoxin B
    • NICE do not currently support its use to prevent recurrences as it is not cost-effective
  • faecal microbiota transplant
    • may be considered for patients who’ve had 2 or more previous episodes
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