Clostridium Difficile infection

Question 1

What type of bacteria if Clostridium Difficile?

Answer 1

Gram positive bacteria

Question 2

What does Clostridium Difficile cuase?

Answer 2

Pseudomembranous colitis

Question 3

Who does Clostridium Difficile normally affect?

Answer 3

People who have been on broad spectrum antibiotics

Question 4

What does Clostridium Difficile produce?

Answer 4

Toxins

Question 5

What do the toxins that Clostridium Difficile produce cause?

Answer 5

Inflammation
Diarrhoea
Development of pseudomembrane in large bowel

Question 6

What is the main risk factor for a Clostridium Difficile infection?

Answer 6

Patient has been treated with a broad spectrum antibiotics

Question 7

What are examples of broad spectrum antibiotics?

Answer 7

Clindamycin
Cephalosporin
Ciprofloxacin
Co-amoxiclav
Penicillin
Omeprazole (PPI)

Question 8

What are other possible risk factors of a Clostridium Difficile infection?

Answer 8

Hospital setting
Over 65
Immunocompromised
PPI’s

Question 9

What are the clinical features of a Clostridium Difficile infection?

Answer 9

Watery diarrhoea (bloody)
Painful abdominal cramps
Nausea
Loss of appetite and weight loss

Question 10

What is the first line management of a mild to moderate Clostridium Difficile infection?

Answer 10

Oral Vancomycin (10 days)

Question 11

What is the first line management of a moderate to severe Clostridium Difficile infection?

Answer 11

Vancomycin and IV metronidazole

Question 12

What is the management of a recurrent Clostridium Difficile infection?

Answer 12

Faecal transplant

Question 13

What are the possible complications of a Clostridium Difficile infection?

Answer 13

Colonic distension- Toxic megacolon

Question 14

What drugs should be stopped in someone with a clostridium difficile infection?

Answer 14

Opioids

Question 15

What are the main complications of a clostridium difficile infection?

Answer 15

Sepsis
Colonic distension- Toxic megacolon

Question 16

What is second line to vancomycin if it is ineffective?

Answer 16

Fidaxomicin

Question 17

What drugs should be avoided in someone with clostridium difficile infection?

Answer 17

Anti-diarrhoeal agents

Question 18

What are examples of cephalosporins?

Answer 18

cefadroxil
cefazolin
cephadrine
cephalexin

Question 19

What is psuedomembrane colitis?

Answer 19

Swelling or inflammation of the large intestine (colon)

Question 20

What can be used to determine the severity of the clostridium difficile infection?

Answer 20

The white cell count

Question 21

What might you see on a sigmoidoscopy of someone with clostridium difficile infection?

Answer 21

Sigmoidoscopy reveals yellow plaques.

Question 22

What medication should be used to treat a recurrent infection within 12 weeks of symptom resolution?

Answer 22

Oral fidaxomicin

Question 23

What can be used to determine the severity of the condition?

Answer 23

WCC

Question 24

What is classified as a moderate c.diff infection?

Answer 24

↑ WCC ( < 15 x 109/L)
Typically 3-5 loose stools per day

Question 25

What is classified as a serve c.diff infection?

Answer 25

↑ WCC ( > 15 x 109/L)
or an acutely ↑ creatinine (> 50% above baseline)
or a temperature > 38.5°C
or evidence of severe colitis(abdominal or radiological signs)

Question 26

What is classified as a life threatening c.diff infection?

Answer 26

Hypotension
Partial or complete ileus
Toxic megacolon, or CT evidence of severe disease

Question 27

How is a c.diff infection diagnosed?

Answer 27

C. difficile toxin (CDT) in the stool

Question 28

What is the issue with looking at the c.diff antigen?

Answer 28

C. difficile antigen positivity only shows exposure to the bacteria, rather than current infection