Clostridium difficile Flashcards
What is C diff
A gram +ve bacilli which causes infection of the colon, causing inflammation and formation of pseudomembrane
How does C diff cause disease?
It makes an exotoxin which causes inflammation
What are risk factors for C diff?
It only occurs in people with disrupted flora e.g.
recent Abx use
immunocompromised
PPIs
hospital stay
IBD
HIV
Hx of c diff
immunosuppression
What Abx can cause C diff
Clindamycin
Cephalosporins e.g. ceftriaxone, cephalexin
Ciprofloxacin
What are Sx of C diff
Abdominal pin
diarrhoea
fever
More severe cases can have symptoms of fulminant colitis e.g. bowel perforation
What are severity markers indicating severe C diff?
Colonic dilatation > 6cm
WCC > 15
temperature > 38.5
immunosuppressoin
What Ix in c diff>
FBC: raised WCC, CRP
FOB: often +ve
Stool PCR, immunoassay, calprotectin
AXR: looking for abdominal distension
CXR: can show pneumoperitoneum
What are DDx for c diff>
IBD
gastroenteritis
Antibiotic associated diarrhoea (this will have no fever)
Ischaemic colitis
What is Rx of c diff?
mild: oral metronidazole
severe: oral vancomycin or fidaxomicin
Discontinue any causative agents, give fluids, infection control measures
What are complications of c diff?
Recurrence
Fulminant C diff
Ileus
Perforation
Toxic megacolon
How is recurrence treated?
Abx e.g. vancomycin, fidaxomicin
Faecal microbiota transplantation.
What is fulminant C diff and how is it treated?
C diff with significant systemic toxic effects and shock, resulting in need for colectomy.
Give vancomycin and metronidazole
Surgery needed in those with rising WCC/lactate
Subtotal colectomy with preservation of rectum or diverting loop ileostomy
What is ileus and how is it treated
disruption of normal propulsive ability of intestine due to faulty peristalsis, presenting with nausea and vomiting with AXR showing small bowel dilation
Insert NG tube and supportive until it resolves
How does perforation present and how is it treated?
Acute abdomen, pain, rebound tenderness, fever, hypotension, tachycardia
Supportive, IV metronidaole, rectal/NG vanc
Laparotomy with colectomy as an emergency
What is toxic megacolon and how is it treated
Severe dilation of colon, presenting with same as perforation
Need IV/NG/rectal met or vanc
Colectomy in severe
