CLW2 CDI Flashcards
What are the risk factors for contracting CDI? (9)
Age > 65
Multiple comorbidities
Immunosuppression
History of CDI
GI surgery
Tube feeding
Prior hospitalisation and duration
Residence in LT care facilities
Use of abx or PPIs
What are the 5 means to control and prevent CDI?
- Isolation (private room and toilet)
- Hand hygiene (soap and water)
- Env cleaning (with sporicidals)
- Antimicrobial stewardship
- Others (probiotics)
What is the cardinal symptom of CDI?
3 or more watery stools that cannot be explained by other reasons in 24 hours
What is the clinical presentation of mild CDI? (2)
Diarrhea and abdominal cramps
What is the clinical presentation of moderate CDI?
Diarrhea, abdominal cramps
Fever, malaise, leukocytosis, hyopovolemia
What is the clinical presentation of severe CDI?
fever, diarrhea, diffused abdominal cramps
WBC ≥ 15x10^9/L or
SCr ≥ 133 μmol/L
What is the clinical presentation of fulminant CDI?
hypotension, shock, ileus, megacolon
How is CDI diagnosed? (2)
(hint: x/x AND y/y)
Presence of diarrhea (3 unformed stools in 24h) or radiographic evidence of ileus or toxic megacolon
and
positive stool test for CDiff or its toxics or histopathological evidence of pesudomembranous colitis
What are the 4 tests that can be done for CDI?
NAAT
PCR
EIA
GDH (glutamate dehydrogenase)
What does NAAT and PCR tell us?
Identifies the genes that produces toxins A and B
Does not reveal if it is activated
What does EIA and GDH tell us?
If C. diff is present
Does not identify if it is toxic or not
What is the first line and alternative treatment for non-severe CDI?
First line: PO vancomycin 125mg QDS
Alt: PO metronidazole 400mg TDS (low risk)
What is the treatment for severe CDI?
(ie. WBC ≥ 15 x 10^9/L OR SCr ≥ 133 μmol/L)
PO vancomycin 125mg QDS
What is the treatment for fulminant CDI? (ie. hypotension or ileus or megacolon)
IV metranidazole 500mg* q8h with PO vancomycin 500mg QDS with or without PR vancomycin 500mg QDS (per rectal soln)
What is the tapered dose for recurrent treatment if vancomycin was used for initial treatment?
125mg QDS x 10-14days
125mg BD for 7days
125mg OD x 7days
125mg every 2-3 days for 2-8weeks