Medicine Specialties A - C DIFF FLASHCARDS

Question 1

What is C.Difficile? (what type of organism)

Answer 1

C. Difficile is a type of spore forming bacteria - anaerobic gram positive bacilli

Question 2

What percentage of the adult population is C.difficile found in? It is always harmful?

Answer 2

C.Difficile is found in 2-5% of the population It does not require oxygen and can live well with other bacteria without causing harm

Question 3

What can cause a C.Diff infection?

Answer 3

Some antibitoics or enteral feeds can affect the normal bowel flora allowing Cdiff the chance to multiply and produce toxins which can cause illness - C diff infection

Question 4

Which antibiotics are most commonly associated with C diff infections?

Answer 4

Clindamycin - lincosamide Co-amoxiclav (amoxicillin + clavulanic acid) Ciprofloxacin - and other quinolones Cephalosporins

Question 5

What is the biggest risk factor for a Cdiff infection?

Answer 5

Previous exposure to ABx is the main risk factor for developing C diff

Question 6

Describe the stages in which patients acquire a C diff infection?

Answer 6

Patients receive AB or enteral feeding Patient alters normal gut flora Patient ingests C diff spores after touching contaminated surfaces Depending on the virulence of the organism and patient - can cause asymptomatic colonisation or C.diff multiples and releases toxins

Question 7

Who is at risk of C diff infection?

Answer 7

Increased age Patients who have used antibiotics in the last 3 months (especially the 4Cs) Prolonged hospital stay Immunosuprresed use of PPIs Previous Cdiff Surgical procedures especially involving the bowel

Question 8

Stopping the spread of C diff * ISOLATE THE PATIENT * Review antibitoics * PPE * Decontaminate equipment * Hand hygiene How long should a patient be isolated for? What should you wash your hands with?

Answer 8

Patient should be isolated in a single room with en-suite facilities until at least 48 hours symptom free and patients bowel habits have returned to normal Hands should be washed with warm water and soap (NOT ALCOHOL BASED GEL) in patients with C diff

Question 9

What percentage of patients will Cdiff recur in?

Answer 9

C diff will recur in 20% of patients

Question 10

When is a patient considered to be clear of Cdiff?

Answer 10

Once the patient has been asymptomatic for 48 hours and bowel habits have returned to normal NO SPECIMEN NEEDED TO CONFIRM

Question 11

What are the three main symptoms of C diff?

Answer 11

Diarrhoea - may be bloody Abdominal cramping Bloating

Question 12

What is the treatment of C.diff? (non severe, severe, recurrent)

Answer 12

Non severe - oral metronidazole Severe - oral vancomycin Severe complicated (eg non -responder or ileus) - vancomycin + IV metronidazole Recurrent - oral fidomaxacin