CLW2 CDI

Question 1

What are the risk factors for contracting CDI? (9)

Answer 1

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

Question 2

What are the 5 means to control and prevent CDI?

Answer 2

1. Isolation (private room and toilet)
2. Hand hygiene (soap and water)
3. Env cleaning (with sporicidals)
4. Antimicrobial stewardship
5. Others (probiotics)

Question 3

What is the cardinal symptom of CDI?

Answer 3

3 or more watery stools that cannot be explained by other reasons in 24 hours

Question 4

What is the clinical presentation of mild CDI? (2)

Answer 4

Diarrhea and abdominal cramps

Question 5

What is the clinical presentation of moderate CDI?

Answer 5

Diarrhea, abdominal cramps
Fever, malaise, leukocytosis, hyopovolemia

Question 6

What is the clinical presentation of severe CDI?

Answer 6

fever, diarrhea, diffused abdominal cramps

WBC ≥ 15x10^9/L or
SCr ≥ 133 μmol/L

Question 7

What is the clinical presentation of fulminant CDI?

Answer 7

hypotension, shock, ileus, megacolon

Question 8

How is CDI diagnosed? (2)

(hint: x/x AND y/y)

Answer 8

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

Question 9

What are the 4 tests that can be done for CDI?

Answer 9

NAAT
PCR
EIA
GDH (glutamate dehydrogenase)

Question 10

What does NAAT and PCR tell us?

Answer 10

Identifies the genes that produces toxins A and B
Does not reveal if it is activated

Question 11

What does EIA and GDH tell us?

Answer 11

If C. diff is present
Does not identify if it is toxic or not

Question 12

What is the first line and alternative treatment for non-severe CDI?

Answer 12

First line: PO vancomycin 125mg QDS

Alt: PO metronidazole 400mg TDS (low risk)

Question 13

What is the treatment for severe CDI?
(ie. WBC ≥ 15 x 10^9/L OR SCr ≥ 133 μmol/L)

Answer 13

PO vancomycin 125mg QDS

Question 14

What is the treatment for fulminant CDI? (ie. hypotension or ileus or megacolon)

Answer 14

IV metranidazole 500mg* q8h with PO vancomycin 500mg QDS with or without PR vancomycin 500mg QDS (per rectal soln)

Question 15

What is the tapered dose for recurrent treatment if vancomycin was used for initial treatment?

Answer 15

125mg QDS x 10-14days
125mg BD for 7days
125mg OD x 7days
125mg every 2-3 days for 2-8weeks

Question 16

What should be given for recurrent CDI if metronidazole was used for initial treatment?

Answer 16

PO vancomycin 125mg QDS x 10days

Question 17

How long should CDI be treated for?

Answer 17

10 days, extend for 14 if need