Clostridioides Difficile Infection Flashcards
How is C. Diff transmitted from person to person?
Through the fecal-oral route
Risk factors for C. diff infection
-Antibiotic exposure
-Healthcare exposure
-Age over 65
-Proximity to a person with a C. diff infection
-Use of acid suppressing agents (PPI, H2RA)
-Chemotherapy
-Immunosuppression
-GI injury
Which antibiotics increase the risk for C. diff?
-FQs
-Clindamycin
-Third and fourth generation cephalosporins
-Carbapenems
Two primary symptoms of C. diff
-Profuse, watery or mucoid green, foul-smelling diarrhea
-Abdominal pain
When should you test for C. diff infection?
3 or more profuse, watery or mucoid green, foul-smelling stools in 24 hours
Three tests used for C. diff
-Nucleic acid amplification test (NAAT) alone (in conjunction with signs/symptoms)
-Antigen test (GDH) + toxin A/B test (NAAT used to resolve discordant results)
-NAAT + Toxin A/B test
How would you define non-severe C. diff infection?
-WBC less than or equal to 15,000
-SCr less than 1.5
How would you define severe C. diff infection?
-WBC over 15,000
-SCr over 1.5
How would you define fulminant C. diff infection?
-Hypotension or shock
-Ileus
-Toxic megacolon (medical emergency)
Treatment options for C. diff infections
-Oral vancomycin
-Fidaxomicin
-Metronidazole (only used for fulminant cases as additional agent)
Considerations for oral vancomycin
-4x daily dosing
-Liquid version has bitter taste
-Low cost and typically covered by insurance (liquid version more costly)
Considerations for fidaxomicin
-Twice daily dosing
-Higher rates of sustained treatment response and lower recurrence rates when compared to vancomycin
-It is very expensive but insurance coverage is increasing
Considerations for metronidazole
-Good oral absorption (bad because we want it to stay in the stomach)
-Three times daily dosing
-Less efficacious and higher risk of recurrence
-Least costly option
-Last-line treatment
What medication should be avoided in C. diff patients?
Loperamide or any peristaltic agents
What is the treatment approach to recurrent CDI?
-Change the drug or dosing regimen
-Fidaxomicin extended dosing regimen
-Vancomycin tapered and pulsed dosing regimen
Treatment for fulminant CDI
-Vancomycin PO + metronidazole IV
-If ileus present, consider rectal vancomycin
Risk factors for CDI recurrence
-Age 65 or more
-Severe CDI on presentation
-Immunocompromised host
What is a fecal microbiota transplant (FMT)?
-Administration of fecal material from healthy person to restore a balanced gut microbiome
-Utilized as both a treatment option and method to reduce recurrence
What are possible indications for FMT?
-Three or more episodes of CDI
-Poor response to initial antibiotic therapy for CDI
How are FMTs administered?
Requires administration via endoscopy, colonoscopy, or rectal tube
What is Rebyota?
-Fecal microbiota suspension
-Administered via rectal tube
What is Vowst?
-Bacterial spore suspension
-Administered via oral route
What is bezlotoxumab?
-Monoclonal antibody targeting C. diff toxin B to neutralize its effect
-Potentially increased risk of CHF and mortality
-Prevents CDI recurrence for patients at high risk
