Clostridium Difficile Infection

Question 1

What is it?

Answer 1

Infection which is common cause of healthcare associated diarrhoea, part of normal bacterial flora but the 2 toxins Toxin A and Toxin B when released cause symptoms

Question 2

Who gets it?

Answer 2

When ABs are prescribed which kill the normal competitive bowel flora and allows C. Difficile overgrowth.
This can be passed between patients

Question 3

What is toxin A?

Answer 3

Enterotoxin

Question 4

What is Toxin B?

Answer 4

Cytotoxin

Question 5

What type of bacteria are C. Difficile?

Answer 5

Gram +ve spore bearing bacillus

Question 6

How does C. Difficile present?

Answer 6

Diarrhoea- sometimes bloody
Abdominal pain
In severe cases there can be progression to pseudomembranes colitis or bowel perforation

Question 7

How is it diagnosed?

Answer 7

Diagnostic: stool PCR for Toxin A/B 
Elisa: if stool antigen test positive 
Bloods: U&Es
AXR- TMC 
Sigmoidoscopy (pseudomembrane colitis)

Question 8

Results of testing for C. Diff?

Answer 8

Screening test neg= negative result
Screening test positive, toxin test positive= Positive result
Screening test pos, toxin test negative= Indeterminate result: ass ptnt and repeat
If repeat indeterminate, clinical decision required

Question 9

How is C. Diff treated?

Answer 9

Less severe: oral metrondiazole
Severe: Oral vancomycin
Hand washing- not just gel

Question 10

What can cause C Diff?

Answer 10

Use of any AB

Most commonly associated: Clindamycin, co-amoxiclav, cephalosporin, ciprofloxacin (fluroquinolines)