Infections lecture 4: HCAIS and clostridium difficile

Question 1

What is clostridium difficile responsible for? Symptom wise?

Answer 1

Antibiotic associated diarrhoea

Question 2

Describe the properties of C.diff, such as gram stain?

Answer 2

Gram postive

Anaerobic

Spore forming rod

Question 3

When C.diff is disrupted what can it produce and where does this come from

Answer 3

Toxin A: fluid secretion and intestinal inflammation

Toxin A and B: both activate cytokine release

Trend towards more severe disease with binary toxin

Question 4

Where is C.diff more likely to occur at? Location wise

Answer 4

Hospital and nursing homes

Question 5

Describe the pathogenesis of C.diff

Answer 5

Caused by pre-existing illness and antibiotic therapy that alters healthy bacterial flora of colon

Faecal oral spreads via spores on surface- asymptomatic colonisation

The toxins produced by C.diff causes diarrhoea

Question 6

What are the stages of progress in C.diff

Answer 6

Uncolonised

Asymptomatic colonisation

Toxin

CDI

Question 7

What does a higher concentration of anti-toxin A do

Answer 7

Leads to less duration of illness and decreased recurrence risk

Question 8

What are the symptoms of c.diff infection

Answer 8

Mild to moderate diarrhoea (or severe)

Abdominal Cramping

Severe: pseudomembranes- yellowish plaques on intestinal mucosa

Low grade fever and dehydration

Question 9

How do you diagnose C.diff

Answer 9

Presence in stools

Identification of symptoms of cramping, diarrhoea, fever

Laboratory abnormalities: low albumin and white cell count

Question 10

What are the risk factors for C.diff infection

Answer 10

Increasing age

Anti-ulcer meds (PPI)

Long duration hospital stay

Presence of underlaying disease (IBD)

LONG DURATION OF ANTIMICROBIAL THERAPY

Cause of multiple antibiotics and microbials

Question 11

What is the common antimicrobials associated with C.diff

Answer 11

CLINDAMYCIN (MAIN)

Cephalosporins
Penicillins
Carbapenems
Amino glycosides 
Fluroquinolones

Question 12

How do you manage C.diff

Answer 12

Stop antimicrobial therapy temporarily until the symptoms clear and restart treatment

Treat fluid and electrolyte replacement but do not use antidiarrhoeals

Question 13

What is the specific treatment of C.diff

Answer 13

VANCOMYCIN

125 to 500mg FOUR times a day

DO not give IV vancomycin

METRONIDAZOLE (FIRST LINE)

400mg THREE times a day

Can use IV For more severe causes

Question 14

What is the new treatment of C.diff called

Answer 14

Fidaxomicin

Question 15

How do you normally prevent outbreaks of C.diff and reduce cases

Answer 15

Good infection control:

Hand washing

patient isolation

Barrier nursing

Increased surveillance