Clostridium Difficile infection Flashcards
What type of bacteria if Clostridium Difficile?
Gram positive bacteria
What does Clostridium Difficile cuase?
Pseudomembranous colitis
Who does Clostridium Difficile normally affect?
People who have been on broad spectrum antibiotics
What does Clostridium Difficile produce?
Toxins
What do the toxins that Clostridium Difficile produce cause?
Inflammation
Diarrhoea
Development of pseudomembrane in large bowel
What is the main risk factor for a Clostridium Difficile infection?
Patient has been treated with a broad spectrum antibiotics
What are examples of broad spectrum antibiotics?
Clindamycin
Cephalosporin
Ciprofloxacin
Co-amoxiclav
Penicillin
Omeprazole (PPI)
What are other possible risk factors of a Clostridium Difficile infection?
Hospital setting
Over 65
Immunocompromised
PPI’s
What are the clinical features of a Clostridium Difficile infection?
Watery diarrhoea (bloody)
Painful abdominal cramps
Nausea
Loss of appetite and weight loss
What is the first line management of a mild to moderate Clostridium Difficile infection?
Oral Vancomycin (10 days)
What is the first line management of a moderate to severe Clostridium Difficile infection?
Vancomycin and IV metronidazole
What is the management of a recurrent Clostridium Difficile infection?
Faecal transplant
What are the possible complications of a Clostridium Difficile infection?
Colonic distension- Toxic megacolon
What drugs should be stopped in someone with a clostridium difficile infection?
Opioids
What are the main complications of a clostridium difficile infection?
Sepsis
Colonic distension- Toxic megacolon
What is second line to vancomycin if it is ineffective?
Fidaxomicin
What drugs should be avoided in someone with clostridium difficile infection?
Anti-diarrhoeal agents
What are examples of cephalosporins?
cefadroxil
cefazolin
cephadrine
cephalexin
What is psuedomembrane colitis?
Swelling or inflammation of the large intestine (colon)
What can be used to determine the severity of the clostridium difficile infection?
The white cell count
What might you see on a sigmoidoscopy of someone with clostridium difficile infection?
Sigmoidoscopy reveals yellow plaques.
What medication should be used to treat a recurrent infection within 12 weeks of symptom resolution?
Oral fidaxomicin
What can be used to determine the severity of the condition?
WCC
What is classified as a moderate c.diff infection?
↑ WCC ( < 15 x 109/L)
Typically 3-5 loose stools per day
What is classified as a serve c.diff infection?
↑ 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)
What is classified as a life threatening c.diff infection?
Hypotension
Partial or complete ileus
Toxic megacolon, or CT evidence of severe disease
How is a c.diff infection diagnosed?
C. difficile toxin (CDT) in the stool
What is the issue with looking at the c.diff antigen?
C. difficile antigen positivity only shows exposure to the bacteria, rather than current infection
