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PR3124 FINALS > Infectious diarrhea and CDAD > Flashcards

Infectious diarrhea and CDAD Flashcards

1
Q

Definition of acute

A

Increased frequency of defecation lasting <14 days

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2
Q

Definition of diarrhea

A

> =3 loose or liquid stools, OR more frequent than normal for an individual

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3
Q

What are the types of microorganisms that can cause acute infectious diarrhea?

A

Bacterial, protozoal, viral

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4
Q

What are the diagnostic tests used to diagnose acute infectious diarrhea?

A

Fecal occult blood, ova and parasite, stool cultures, polymerase chain reaction (PCR)

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5
Q

Why might stool cultures not be commonly done in practice?

A

Acute infectious diarrhea is self-limiting, and since stool cultures take a few days, patients may already be recovered when the results are back

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6
Q

For which patients are diagnostic tests indicated for?

A 
Immunosuppressed
Unresponsive to treatment 
Bloody stools 
Persistent fever 
Severe illness
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7
Q

What vaccinations are recommended for those travelling to countries with poor sanitation status?

A

Typhoid (Salmonella typhi) and Cholera (Vibrio cholera)

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8
Q

What vaccinations are recommended for infants or children 6 months - 5 years for the prevention of acute infectious diarrhea?

A

Rotavirus

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9
Q

Non-pharmacologic treatment of acute infectious diarrhea

A

Early re-feeding as tolerated

Easily digestible food (e.g. crackers, toast, cereal, bananas)

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10
Q

Do all patients require antibiotics? What are the indications for antibiotics?

A

No, most are self-limiting

Severe disease (fever with bloody diarrhea, OR mucoid stools, OR severe abdominal pain/cramps/tenderness)
Sepsis
Immunocompromised

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11
Q

What is the empiric antibiotic therapy for acute infectious diarrhea?

A

Ceftriaxone 2g IV q24h

Ciprofloxacin 500mg PO BD

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12
Q

What is the duration of therapy for acute infectious diarrhea? When is it extended?

A

3-5 days

Extended in patients with bacteremia, extra intestinal infections or immunocompromised patients

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13
Q

Is IV to PO step down therapy needed for acute infectious diarrhea?

A

No, as antibiotic duration is already very short

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14
Q

What type of bacteria is C difficile?

A

Gram positive, spore forming anaerobic bacillus producing Toxins (A and B)

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15
Q

How is C difficile transmitted?

A

Fecal oral route
Contaminated environmental surfaces
Hand carriage by healthcare workers

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16
Q

What is the pathogenesis of C difficile infection?

A

Alteration to normal gut flora
C difficile spores are passed from patient to patient
Spores enter the intestine, start to replicate and produces toxins
Toxins damages the GI mucosa that causes bleeding and other symptoms of C difficile

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17
Q

What are the types of risk factors for C diff infection?

A

Healthcare exposure
Pharmacotherapy
Patient-related factors

18
Q

What are the healthcare exposure related risk factors for C difficile infection?

A

Prior hospitalisation
Duration of hospitalisation
Residence in nursing home or long-term care facilities

19
Q

What are the pharmacotherapy related risk factors for C diff infection?

A

Systemic antibiotics (no of agents, duration of therapy)
High risk antibiotics (clindamycin, fluoroquinolones, 2nd of higher generation cephalosporins)
Use of gastric acid suppressive therapy

20
Q

What are the patient-related risk factors for C diff infection?

A

Multiple or severe comorbidities
Immunosuppression
Age > 65 years
history of CDI

21
Q

What are the symptoms of fulminant/severe CDI?

A

Ileus, toxic megacolon, pseudomembranous colitis, perforation, death

22
Q

What is the clinical suspicion for C difficile infection?

A

New and unexplained onset of diarrhea

Radiologic evidence of ileus or toxic megacolon

23
Q

What is the confirmatory test for C diff infection?

A

Positive stool test for C difficile or its toxins

Histopathologic evidence of pseudomembranous colitis

24
Q

What are the diagnostic tests for C diff infection?

A

Nucleic acid amplification test (toxin enzyme immunoassay, glutamate dehydrogenase EIA)
PCR

25
Q

Do we test asymptomatic patients for C diff infection?

A

No, always starts with clinical suspicion, which is based on symptoms

26
Q

After diarrhea resolves, how long is contact precautions recommended for (ie gloves and gown wearing)?

A

48 hours

27
Q

When is empiric CDI treatment recommended?

A

Substantial delay (>48 hours) in diagnostics, OR fulminant CDI

28
Q

What is the definition of a non-severe episode of C difficile infection?

A

WBC < 15 x 10^9/L AND Scr < 133 umol/L (1.5mg/dL)

29
Q

What is the definition of a severe episode of C difficile infection?

A

WBC >= 15x10^9/L OR SCr >= 133umol/L (1.5mg/dL)

30
Q

What is the definition of fulminant C difficile infection?

A

toxic megacolon OR ileus OR hypotension OR pseudomembranous colitis

31
Q

When is vancomycin given as enema?

A

When there is ileus

32
Q

What drug is given IV for the treatment of C diff infection and under what circumstances?

A

Metronidazole

When patient has fulminant C diff infection

33
Q

What is the recommended treatment for non-severe C diff infection?

A

First line: vancomycin 125mg PO QDS, Fidaxomycin 200mg PO BD

Alternative: metronidazole 400mg PO TDS

34
Q

What is the recommended treatment for severe C diff infection?

A

Vancomycin 125mg PO QDS

Fidaxomicin 200mg PO BD

35
Q

What is the recommended treatment for fulminant C diff infection?

A

Metronidazole IV 500mg Q8H
Vancomycin 500mg PO QDS
Vancomycin 500mg PR QDS

36
Q

Treatment duration for initial episode of C diff infection

A

10 days

37
Q

When should metronidazole not be considered?

A

Patient has repeated or prolonged courses (as potentially irreversible neurotoxicity)

38
Q

What are the treatment options for first recurrence?

A

If treated with metronidazole:
Treat with vancomycin 125mg PO QDS x10 days

If treated with first line regimen first episode:
Fidaxomicin 200mg PO BD x 10 days
Vancomycin PO taper

39
Q

What are the treatment options for second or subsequent recurrence?

A

Fidaxomicin 200mg PO BD x 10 days
Vancomycin PO taper
Vancomycin 125mg PO QDS x 10 days followed by rifaximin 300mg PO TDS x 20 days
Fecal microbiota transplant

40
Q

If a patient is receiving 4 weeks pip-tazo for treatment of his DFI and subsequently develops C difficile infection, how long should he stay on Vancomycin?

A

10 days

41
Q

Are anti-motility agents recommended for use during C diff infection?

A

No, it reduces bowel output, affecting ability to perform stool testing. Associated with poor outcomes

PR3124 FINALS (7 decks)

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