ID and CDiff Flashcards
What is the main cause of death due to infectious Diseases?
Dehydration
Who are those at risk for infectious diseases?
Ages <5 and >74
Immunocompromises
Travelers/Military
Chronic Care Institutions
What is the leading global cause of Infectious Diseases? Viral or Bacterial?
Viral
Viral ID Pathogens
Rotavirus/Adenovirus (6 mos-2 yrs)
Noravirus (all ages)
Bacterial ID Pathogens
Shigella
Salmonella
E. Coli
S. aureus
C. diff
Parasitic ID Pathogens
Entamoeba
Giarda
Crypto
Round/Tapeworm
Traveller’s Diarrhea Onset
5 - 15 days
Traveller’s Diarrhea Therapy
Loperamide 2 mg PRN X 2 days
Would you give ABx in Traveller’s Diarrhea?
Only in High risk
What ABx’s to give in high risk Traveller’s Diarrhea?
TMP/SMX
Ciprofloxacin
Norfloxacin
Which one is more important water loss of ABx? (ie most effect)
Water loss
Symptoms of Mild Water Loss
<5% BW lost
Increased thirst
Slightly dry mucous membrane
Slightly decreased urine output
Symptoms of Moderate Water Loss
6 - 9% BW lost
Lethargic
Low BP; High HR
Dark urine
Dry mucous membrane
Symptoms of Severe Water Loss
> 10% BW lost
Loss of Consciousness
Cyanotic
Bradycardic
Treatment for Water Loss
Supportive Care: Rehydration and Elytes
Mild-Mod: ORT
Sever: IV Fluids
What is the most common microbial that causes healthcare associated infections?
CDiff
Pathogenesis of CDiff Infection
Fecal-oral route spores - large intestine - mature - toxin production
Biggest factor in CDiff Infection?
Antibiotic exposure
Patient Specific Risk factors
Immunocompromised
Age >65
Tube feeding
GI surgery
Facility Related Risk Factors
Length of stay
ICU admission
Exposure
Medication Related Risk factor
Acid-Suppressing Agents
Chemo
Antibiotics
Antibiotics that are a risk factor in CDiff
Clindamycin
Fluoroquinolones
Cephalosporins (3rd/4th gen)
Carbapenems
Erythromycin
Ampicillin
Tetracycline
Aminoglycosides
Vancomycin
Metronidazole
Non-Severe CDiff Presentation
Leukocytosis WBC <15K and SCr <1.5
Severe CDiff Presentation
Lekocytosis WBC >15K or SCe >1.5
Fulminant CDiff Presentation
Hypotension
ileus
Megacolon
Manifestation of CDI
ABx associated diarrhea without colitis
ABx associated colitis without Pseudomonas
Pseudomonas colitis
ABx associated diarrhea without colitis
~6 loose stools/day
AB associated colitis without pseudomembranes
10+ loose stools a day
Pseudomonas colitis
> 10 loose stools a day; elyte imbalance
What is pseudomembranous colitits?
irregular yellow plaques of necrosis indicative/caused by CDiff Infection
How to diagnose CDiff?
> 3 unformed stools in 24 hours + CDiff +ve stool test
OR
3 unformed stools in 24 hours + pseudomembranous colitis
Gold standard test for CDiff toxin strain?
EIA detection of GDH + cell cytotoxicity assay
True or False. You shoud test formed stool.
False
What medications should you not use with a CDiff infection?
Loperamide
Narcotics
General management of CDiff
No anti-peristaltics
Supportive care: water and elyte balance
Stop any AB use
IDSA Treatment Guidelines for Non-Severe Infection
Vancomycin 125 mg PO QID x10days
Fidaxomicin 200 mg PO BID x10 days
Metronidazole 500 mg PO tID x10 days
IDSA Treatment Guidelines for Severe Infection
Vancomycin 125 mg QID x10 days
Fidaxomicin 200 mg BID x10 days
IDSA Treatment Guidelines for Severe, Complicated Infection
Vancomycin 500 mg PO/NG QID
+
Metronidaole 500 mg IV Q8H (if ileus present)
True or False. Vancomycin and Fidaxomicin have similar efficacy
True
How do you approach CDiff infection that keeps recurring?
A tapered approach and a pulsed approach
What medications have shown high efficacy in recurrent infections?
Actoxumab
Bezlotoxumab
When does a fecal transplant become feasible?
Severe recurrent CDI
multiple recurrences who failed ABx regimen
Who can be a donor for a fecal transplant?
Intimate partner
Housemate
Family member
How is the fecal transplant done?
It is done within 24 hours of donation in the distal lower GI tract
How to prevent CDiff Infection?
Soap and hot water (Not sanitizer)
