Lecture 9 C. difficile Flashcards
What is CDAD
Clostridium difficile associated disease
What is the hypervirulent and hypertoxic strain from canada
Ribotype 027
How can a c diff infection be characterised
Faecal-oral transmission
Food associated infection
Food-poisoning
Antibiotic associated diarrhoea
What is the difference between food associated infection and food poisoning
Food associated infection is where food acts as vehicle for transmission, so food handlers contaminate the food and then the pathogen is consumed eg. Salmonella sp. , camplyobacter jejuni, ecoli 0157
Food poisoning is where the toxin is present in the food so the toxin (not pathogen) is consumed e.g. Staph aureus
Where is faecal-oral transmission common and whic microbes cause it `
Institutions such as nurseries, with contaminated hands/fomites and food.
Rotavirus, norovirus
How does AAD lead to GI
beta lactams and broad spectrum antibiotics give people diarrhoea so gut become ‘sterile’ lose normal flora so pathogen bacteria overgrowth
E.g. CLOSTRIDIUM DIFFICILE
When was c diff first discovered and what was it named
Bacillus difficilis as hard to grow in 1935
Normal component of faecal flora of 70% newborn babies and 2-3% of healthy adults.
Name some characteristics of morphology and physiology of.c diff
Large GPR 15-20 microns in length Strictly anaerobic Spore forming organism (ubiquitous) Toxin producing >100 different genetic types (ribotypes) Ribotypes 001, 106 and 027 common in UK
Which ribotypes of c diff are common in uk
Ribotypes 001, 106 and 027
What do strictly anaerobic microorganisms use as terminal electron acceptor in ETC
Reduce sulphites instead of oxygen, which are less oxidising . Therefore organism produce less ATP and take longer to grow (approx 2 days)
C difficile is one of the leading HAI in the UK associated with AAD, pseudomembranous colitis and death. true or false
True
What was the approximate number of cases of c diff in hospitals in uk in 2005
46,000
What year did ribotype 027 hit uk
2004
Describe two campaigns introduced (w/ dates) and describe the trend
55,000 cases in 2006
Introduce clean your hands campaign around 2004 - break chain of infection.
2008ish - the deep clean - matrons brought back to wards and responsible for intensive chlorine based disinfection s followed by hydrogen peroxide vapour so can get into nooks and cranny in the ward to get spores.
After this see cases drop to approx 12,000 in 2012
In 2008, _% of death certificates stated c diff was the underlying cause
50%
When was the peak year of 027 strain in hospitals
2007
What are the risk factors for c diff
As spores are transmissible, resistant to antimicrobials and persistent, these are at risk: Hospitalisation Age >65 Broad spectrum antibiotic use Hygiene/dirty environment Close proximity of patients Nasogastric tubes Contaminated equipment e.g blood pressure cuffs.
C. difficile is a commensal, true or false
True
What % of blood pressure cuffs are contaminated with spores and why
33% due to velcro, hard to clean