Lecture 18.1: C. Diff

Question 1

What is C. Diff and how is it transmitted?

Answer 1

• Gram +; Spore Forming; obligate anaerobe
• Person-to-person through Fecal-to-Oral

Question 2

What is the most common/severe strain of C. Diff?

Answer 2

• BI/NAPI/027: makes Toxins A & B

This is highly resistant toward FQ

Question 3

What is the definition of C. Diff?

Answer 3

• New-onset diarrhea thats 3 or more unformed stool in 24 hours

Question 4

What are the 4 critical components of the pathogensis of C. Diff?

Answer 4

• Disruption of Colonic Microflora
• Need source of C. Diff
• Toxins: TcdA & TcdB
• Risk Factors: Antibiotics?, Time in hospital, close to person with it, PPis or H2RAs

Question 5

What are the signs and symptoms of C. Diff?

Answer 5

• Profuse, watery/green, stinky diarrhea
• Cramping
• Leukocytosis [Fulminant]
• Fever [Fulminant]
• Hypoalbuuminemia [Fulminant]
• Toxic Megacolon [what it can become; FATAL]

Question 6

What are some of the treatment considerations for C. Diff?

Answer 6

• D/C the antibiotic & give supportive care
• Empiric treatment ASAP
• AVOID Peristaltics: increase toxic megacolon risk

Question 7

What is the recommened treatment for the Initial C. Diff Episode?

Answer 7

• Fidaxomicin 200mg PO BID x 10d [Preferred]
• Vancomycin 125mg PO QID x 10d [alternative]
• Metronidazole 500mg PO TID x10d [non-severe]

Vanco: Used more often
Metro: Not used too much
Fida: Helps with decreasing the recurrance

Question 8

What is the recommened treatment for First C. Diff Recurrence?

Answer 8

• Fidaxomicin 200mg PO BID x 10d OR BID x 5d then everyother day x 20d [Preferred: to help with recurrence]
• Vancomycin 125mg PO QID x 10d [alternative]
• Bezlotoxumab 10mg/kg IV x 1dose

Can Taper with Vanco
Bez: CAUTION IN CHF

Question 9

What is the recommended treatment fro Second C. Diff Recurrence?

Answer 9

• Fidaxomicin 200mg PO BID x 10d OR BID x 5d then everyother day x 20d [Preferred: to help with recurrence]
• Vancomycin 125mg PO QID x 10d [alternative]
• Fecal Microbiota Tranplant
• Bezlotoxumab 10mg/kg IV x 1dose

Can Taper with Vanco
Bez: CAUTION IN CHF
FMT: ONLY consider when 3 recurrence [Initial, 1st Recurrence, 2ns recurrence = FMT]

Question 10

What is the recommended treatment for Fulminant C. Diff?

Answer 10

• Vancomycin 500mg PO or NG QID
• Metronidazole 500mg IV q8h + PO/PR Vancomycin

Fulminant = Hypotension or Shock; Ileus, Toxic Megacolon

ileus = rectal vancomycin

Question 11

What is important to about Metronidazole in the treatment of C. Diff?

Answer 11

• NO Longer need unless Fidaoxmicin or Vancomycin CANNOT be used
• 100% Bioavailability

Question 12

What is important to know about Vancomycin in the treatment C. Diff?

Answer 12

• Used as Alternative
• VRE possiblity

Question 13

What is important to know about Fidaxomicin in the treatment C. Diff?

Answer 13

• Stays in the GI & doesnt really change the GI flora
• VERY $$$; why we use Vancomycin
• NOT good in Fulminant

Question 14

What is important to know about Fecal Microbiota Transplantation in the treatment of C. Diff?

Answer 14

• Administration of feces from a healthly person to a C. Diff patient
• Trying to restore the GI flora
• Donor: spouse, 1st degree relative, friend…

Question 15

What is Vowst?

Answer 15

• Capsules of poop??
• MOA: Facilitate the GI Microbiome
• $20,000 for 12 caps

Question 16

What is important to know about Bezlotoxumab in the treatment of C. Diff?

Answer 16

• BIND ONLY TO TOXIN B
• CAUTION IN CHF

Question 17

What are some of the important things to note about C. Diff?

Infection Control? Preventions?

Answer 17

• WASH HANDS with soap; hand sanitizers DO NOT kill C. Diff
• DO NOT use probiotics; could cause inflammation more