Clostridioides Difficile Infection Flashcards
Gram stain of Clostridioides difficile
Gram positive bacillus
Anaerobic
Spore forming
Why does use of some antibiotic increase susceptibility to Clostridioides difficile infection?
- They alter + supress healthy normal intestinal micro flora competing for space
- Allows proliferation of Clostridioides difficle + toxin production
What antibiotic is are associated with increased susceptibility to Clostridioides difficile colitis?
Amoxicillin
Clindamycin
Cephalosporins
Fluoroquinoloes
What does a Clostridioides difficle infection cause?
Antibiotic associated diarrhoea + colitis
What can inhibit the growth of Clostridioides difficile?
Why?
Oxygen
C. Difficile is a anaerobic bacteria
Transmission of Clostridioides difficile
Spore transmission
Spore forming bacteria
Why can Clostridioides difficle survive for a long time?
Spore forming bacteria
Spores are resistant to heat, acid + antibiotics
Why does good hand hygiene + regular glove use disruption Clostridioides difficile transmission?
Spores can be transferred to patients via hands of healthcare personnel
Reduces spread
What is the main protective barrier against Clostridioides difficle?
Normal intestinal micro flora
What types of toxins does Clostridioides difficle produce?
A+B
What type of toxin is toxin A from Clostridioides difficle?
Enterotoxin
What type of toxin is toxin B from Clostridioides difficle?
Cytotoxin
What does toxin A from Clostridioides difficle do?
Causes excessive fluid secretion»_space; diarrhoea
Stimulates an inflammatory response»_space; colitis
Has some effect of damaging cell structure
What does toxin B from Clostridioides difficle do?
Damages protein synthesis + cell structure
Risk factors associated with Clostridioides difficle infection
Antibiotic exposure
Older age
Hospitalisation
Immune suppression
Inflammatory bowel disease
When should a diagnosis of Clostridioides difficile colitis be suspected?
- Any patient with diarrhoea
- Received antibiotics in previous 3 months
- Recent hospitalisation and/or diarrhoea within 48 hours after hospitalisation
What are the stages of Clostridioides difficile infection?
Asymptomatic
Mild-moderate
Severe
Severe/complicated
Signs and symptoms of mild or moderate Clostridioides difficile infection
Diarrhoea
Presence of mucus of blood in stool
Fever
Abdominal cramping
Signs and symptoms of severe Clostridioides difficile infection
Leukocytosis
Elevated serum creatinine levels
Pseuedomembranous colitis
Diarrhoea
Signs and symptoms of severe, complicated Clostridioides difficile infection
Ileus - loss of bowel motility
Hypotension
Shock
Sepsis
Abdominal perforation
Diarrhoea
What tests are done on stool samples?
Enzyme immunoassay (EIA)
PCR
What are EIAs used for in diagnosis of Clostridioides difficle infection?
Glutamate dehydrogenase produced by C.difficile
Detecting toxins A + B
What are PCR assay used for in diagnosis of Clostridioides difficle infection?
Toxin gene
What is the aim of tests for Clostridioides difficile?
Identify C.difficile bacteria
Presence of toxin
Treatment of Clostridioides difficile infection
Varies dependent on severity
Mild - oral or IV metronidazole
- oral vancomyocin 10 day
Severe - vancomyosin
Treatment of mild Clostridioides difficile infection without fever, abdominal pain or leucocytosis
Cessation of antibiotics
Treatment of mild-moderate Clostridioides difficile infection
Oral or IV metronidazole
Oral vancomycin
Treatment of severe, complicated Clostridioides difficile infection
vancomycin
Why is vancomycin used to treat of mild severe, complicated Clostridioides difficile infection over metronidazole?
Produces faster symptom resolution
Fever treatment failures
Treatment for relapse infection of Clostridioides difficile
Investigational therapies
Faecal microbiota transplantation to repopulate gut flora
Prevention of Clostridioides difficile infection
Careful use of antimicrobial agents - educate
Emphasise importance of hand washing
Isolate if CDI suspected
Wear PPE when visiting CDI patients
Clean surfaces
Why is hand washing better at preventing Clostridioides difficile infection than hand gel?
Alcohol does not kill C.difficile spores
Drugs used against Clostridioides difficile infection
Vancomycin - serious
Metronidazole - mild
Fidaxomicin
What is faecal microbiota transplantation?
Transfer of stool from healthy donor to patient with CDI to reconstitute normal gut microbial flora
Risk of faecal microbiota translpantation
Transmission of HIV, hepatitis + retrovirus
Virulence factor of Clostridioides difficile
Enterotoxin A
Cytotoxin B
