C.Difficile infection Flashcards
About C.Difficile infection?
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
Leading cause of C diff?
2nd and 3rd generation cephalosporins
Clinical presentation?
- diarrhoea
- abdominal pain
- araised white blood cell count (WCC)is characteristic
- if severe toxic megacolon may develop
Life-threatening presentation?
hypotension
partial or complete ileus
toxic megacolon, or CT evidence of severe disease
Severe presentation?
- 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)
Moderate c diff infection?
high WCC (but less than 15 x 10^9/L)
typically 3-5 loose stools per day
Mild c diff infection?
normal WCC
Treatment of C diff infection? (first episode)
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
treatment of a recurrent episode of C.diff?
- 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
treatment of life-threatening C.diff infection
- oral vancomycin AND IV metronidazole
- specialist advice - surgery may be considered
Other therapies for the treatment of C.diff infection?
- 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