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PHM 604 > ID and CDiff > Flashcards

ID and CDiff Flashcards

1
Q

What is the main cause of death due to infectious Diseases?

A

Dehydration

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2
Q

Who are those at risk for infectious diseases?

A

Ages <5 and >74
Immunocompromises
Travelers/Military
Chronic Care Institutions

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3
Q

What is the leading global cause of Infectious Diseases? Viral or Bacterial?

A

Viral

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4
Q

Viral ID Pathogens

A

Rotavirus/Adenovirus (6 mos-2 yrs)
Noravirus (all ages)

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5
Q

Bacterial ID Pathogens

A

Shigella
Salmonella
E. Coli
S. aureus
C. diff

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6
Q

Parasitic ID Pathogens

A

Entamoeba
Giarda
Crypto
Round/Tapeworm

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7
Q

Traveller’s Diarrhea Onset

A

5 - 15 days

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8
Q

Traveller’s Diarrhea Therapy

A

Loperamide 2 mg PRN X 2 days

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9
Q

Would you give ABx in Traveller’s Diarrhea?

A

Only in High risk

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10
Q

What ABx’s to give in high risk Traveller’s Diarrhea?

A

TMP/SMX
Ciprofloxacin
Norfloxacin

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11
Q

Which one is more important water loss of ABx? (ie most effect)

A

Water loss

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12
Q

Symptoms of Mild Water Loss

A

<5% BW lost
Increased thirst
Slightly dry mucous membrane
Slightly decreased urine output

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13
Q

Symptoms of Moderate Water Loss

A

6 - 9% BW lost
Lethargic
Low BP; High HR
Dark urine
Dry mucous membrane

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14
Q

Symptoms of Severe Water Loss

A

> 10% BW lost
Loss of Consciousness
Cyanotic
Bradycardic

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15
Q

Treatment for Water Loss

A

Supportive Care: Rehydration and Elytes
Mild-Mod: ORT
Sever: IV Fluids

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16
Q

What is the most common microbial that causes healthcare associated infections?

A

CDiff

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17
Q

Pathogenesis of CDiff Infection

A

Fecal-oral route spores - large intestine - mature - toxin production

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18
Q

Biggest factor in CDiff Infection?

A

Antibiotic exposure

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19
Q

Patient Specific Risk factors

A

Immunocompromised
Age >65
Tube feeding
GI surgery

20
Q

Facility Related Risk Factors

A

Length of stay
ICU admission
Exposure

21
Q

Medication Related Risk factor

A

Acid-Suppressing Agents
Chemo
Antibiotics

22
Q

Antibiotics that are a risk factor in CDiff

A

Clindamycin
Fluoroquinolones
Cephalosporins (3rd/4th gen)
Carbapenems

Erythromycin
Ampicillin
Tetracycline

Aminoglycosides
Vancomycin
Metronidazole

23
Q

Non-Severe CDiff Presentation

A

Leukocytosis WBC <15K and SCr <1.5

24
Q

Severe CDiff Presentation

A

Lekocytosis WBC >15K or SCe >1.5

25
Q

Fulminant CDiff Presentation

A

Hypotension
ileus
Megacolon

26
Q

Manifestation of CDI

A

ABx associated diarrhea without colitis
ABx associated colitis without Pseudomonas
Pseudomonas colitis

27
Q

ABx associated diarrhea without colitis

A

~6 loose stools/day

28
Q

AB associated colitis without pseudomembranes

A

10+ loose stools a day

29
Q

Pseudomonas colitis

A

> 10 loose stools a day; elyte imbalance

30
Q

What is pseudomembranous colitits?

A

irregular yellow plaques of necrosis indicative/caused by CDiff Infection

31
Q

How to diagnose CDiff?

A

> 3 unformed stools in 24 hours + CDiff +ve stool test
OR
3 unformed stools in 24 hours + pseudomembranous colitis

32
Q

Gold standard test for CDiff toxin strain?

A

EIA detection of GDH + cell cytotoxicity assay

33
Q

True or False. You shoud test formed stool.

A

False

34
Q

What medications should you not use with a CDiff infection?

A

Loperamide
Narcotics

35
Q

General management of CDiff

A

No anti-peristaltics
Supportive care: water and elyte balance
Stop any AB use

36
Q

IDSA Treatment Guidelines for Non-Severe Infection

A

Vancomycin 125 mg PO QID x10days
Fidaxomicin 200 mg PO BID x10 days
Metronidazole 500 mg PO tID x10 days

37
Q

IDSA Treatment Guidelines for Severe Infection

A

Vancomycin 125 mg QID x10 days
Fidaxomicin 200 mg BID x10 days

38
Q

IDSA Treatment Guidelines for Severe, Complicated Infection

A

Vancomycin 500 mg PO/NG QID
+
Metronidaole 500 mg IV Q8H (if ileus present)

39
Q

True or False. Vancomycin and Fidaxomicin have similar efficacy

A

True

40
Q

How do you approach CDiff infection that keeps recurring?

A

A tapered approach and a pulsed approach

41
Q

What medications have shown high efficacy in recurrent infections?

A

Actoxumab
Bezlotoxumab

42
Q

When does a fecal transplant become feasible?

A

Severe recurrent CDI
multiple recurrences who failed ABx regimen

43
Q

Who can be a donor for a fecal transplant?

A

Intimate partner
Housemate
Family member

44
Q

How is the fecal transplant done?

A

It is done within 24 hours of donation in the distal lower GI tract

45
Q

How to prevent CDiff Infection?

A

Soap and hot water (Not sanitizer)

PHM 604 (11 decks)

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