Clostridial Difficile

Question 1

Risk Factors

Answer 1

Exposure to antibiotics - TALC ( Tetra, Clindamycin, Cephal, Pnc, Fluro)

Extremes of age

Immunosuppression

PPI & H2R

Nursing or Group Care home

Question 2

Complications

Answer 2

Related to infection :

Septic shock

Perfoation

Toxic mega colon

Bleeding

Related to Diarrhoea

Hypovolemia

Hypok+, HypoMg+.

Question 3

Microbiology

Sigmoidoscopy, colonscopy

CT scan

Answer 3

Stool: C.difficile toxin

PCR ffor C.difficile

ELISA for C.diff GAD

Scopy: Pseudomembranes

CT scan: Abd & pelvis

Oral & IV contras - to exclude TM, perf & other DD’s

Question 4

Prevention

Answer 4

Antibiotic stewardship

Limitation of Broad spectrum ABX

HW, alcohol hand rub is ineffective

Question 5

Treatment

Answer 5

Supportive care & resus

Specific

Med: Oral Van 250-500mg Q6h

Metronidazole ( 500mg BD IV or 400mg TDS PO)

Tigecycline

Sur: Colectomy

Others: Monoclonal abx & ? Vaccine

Faecal transplant