Clostridium difficile Flashcards
What type of bacteria is Clostridium difficile?
Clostridium difficile is a gram-positive, rod-shaped, anaerobic bacterium.
What are the main risk factors for Clostridium difficile infection (CDI)?
- Repeated use of antibiotics
- Proton-pump inhibitors (e.g., omeprazole)
- Healthcare settings
How does Clostridium difficile spread?
C. difficile produces spores that are released in faeces. These spores can survive on contaminated surfaces and hands, aiding in the spread to others.
What are the toxins produced by Clostridium difficile, and what do they cause?
- Toxin A (enterotoxin)
- Toxin B (cytotoxin)
These toxins cause diarrhoea, abdominal pain, and can lead to complications such as pseudomembranous colitis and toxic megacolon.
Which antibiotics are most associated with Clostridium difficile infection (CDI)?
- Clindamycin
- Ciprofloxacin (and other fluoroquinolones)
- Cephalosporins
- Carbapenems (e.g., meropenem)
What is the typical presentation of Clostridium difficile infection (CDI)?
- Asymptomatic colonisation is common.
- Infection presents with:
- Diarrhoea
- Nausea
- Abdominal pain
- Severe infection can cause dehydration, fever, tachycardia, and hypotension.
How is Clostridium difficile diagnosed?
Diagnosis is based on stool samples:
* C. difficile antigen (glutamate dehydrogenase test) detects presence.
* A and B toxins are tested by PCR or enzyme immunoassay (EIA).
The antigen test identifies the presence of C. difficile, but the toxin tests confirm the infection’s severity.
What is the first-line treatment for Clostridium difficile infection (CDI)?
- Oral vancomycin is the first-line treatment.
- Oral fidaxomicin is the second-line option.
How should patients with C. difficile infection (CDI) be isolated?
Patients should be isolated until 48 hours after the last episode of diarrhoea to prevent the spread of the infection.
What is faecal microbiota transplantation, and when is it used in C. difficile infection (CDI)?
Faecal microbiota transplantation is used for recurrent cases of CDI. It involves transferring stool microbiome from a donor to the patient via capsules, colonoscopy, or enema.
What are the complications of Clostridium difficile infection (CDI)?
- Pseudomembranous colitis: Inflammation with yellow/white plaques in the colon, visible on colonoscopy.
- Toxic megacolon: Severe colon dilation, which can lead to bowel rupture.
- Other complications include bowel perforation and sepsis.
What is pseudomembranous colitis, and how is it diagnosed?
Pseudomembranous colitis is characterised by yellow/white plaques forming pseudomembranes on the inner bowel wall. It is diagnosed with a colon biopsy and colonoscopy.
What is toxic megacolon, and how is it treated?
Toxic megacolon is a severe complication of C. difficile colitis involving colon dilation, which increases the risk of bowel rupture. Treatment includes supportive care and surgical resection of the affected bowel.
