Exam 4 - C. diff infections Flashcards
what kind of bug is c. diff
GP and spore forming
how is c. diff transmitted
person to person via fecal oral route
what are the main risk factors for c. diff
ABX use, healthcare exposure, greater than 65
what are the main ABX with c. diff risk
FQ, clindamycin, ceftriaxone, carbapenems
what are the other risk factors for c. diff
proximity to c. diff, acid suppressors, chemo, immunosuppression, GI surgery
what is the pathogenesis for c. diff
disruption of colon micro flora
source and intro of c. diff to colon
c. diff multiplies and toxins form
mucosa becomes covered in plaque
when should you test for c. diff
test when 3 or more profuse c. diff stools in 24 hours
what are the 3 testing methods for c. diff
nucleic acid amplification test (NAAT)
antigen test (GDH) and toxin A/B test
NAAT + toxin test
should you repeat test for c. diff
not within 7 days of same episode and not if asymptomatic
what is the classification on non-severe c. diff
WBC < 15,000 and SCr < 1.5
what is the classification of severe c. diff
WBC > 15,000 and SCr > 1.5
what is the classification of fulminant c. diff
hypotension or shock
toxic megacolon
what are the 3 main treatment options for C. diff
oral vanc
fidaxomicin
metronidazole
how many times a day is vanc dosed for c. diff
dose 4x a day PO
poor oral absorption
what is the fidaxomicin dose for c. diff
200mg PO Q12
when should metronidazole be used in c. diff
reserve for fulminant
what is the initial treatment option for non severe or severe c. diff
fidaxomicin 200mg PO Q12 x 10 days
vanc 125mg PO Q6 x 10 days
metro 500 PO Q8 x 10 days (non severe only)
what are the treatment options for 1st recurrence of c. diff
fidaxomicin or vanc x 10 days(whatever was not used the first time)
fidaxomicin x5 days then vanc every other day x20 days
vanc tapered and pulsed
what is the treatment for second recurrence of c. diff
choose a different strategy than previous
what is the treatment for fulminant c. diff
vanc 500mg PO Q6 + metro 500mg IV Q8
if there is an ileus how should c. diff be treated
add vanc via rectum
who is recurrence most likely to occur in
> 65 years, immunocompromised, severe CDI
what are the fecal microbiota transplant options
Rebyota
Vowst
Bezlotuxumab
when can rebyota be given
24-72 hours after treatment completion
when can vowst be given
start 2-4 days after treatment
when can bezlotuxumab be given
during course of CDI treatment
