Exam 3: C. Diff and Intraabdominal Flashcards
What is the BI/NAP1/027 strain of c. diff
more virulent strain
hyper-sporulating and increased production of toxins A and B than previous strains: increase disease severity and mortality; highly resistant to FQ; may be refractory to standard therapy
definition of c. diff
presence of unexplained and new-onset diarrhea in the form of 3 or more unformed stools in 24 hours in conjunction with a positive stool test for c. diff toxins or toxigenic c. diff or colonscopic or histopathologic findings revealing pseumonmembranous colitis
pathogenesis of CDI
- disruption of colonic microflora
- need source for c. diff
- organism must have potential to produce toxn
- Multiple risk factors
clinical manifestations of CDI
- profuse, watery, foul smelling diarrhea
- cramping abd pain
- leukocytosis
- high fevers
- toxic megacolin
laboratory diagnosis of CDI
stool culture of diarrhea
CDI treatment considerations
- d/c treatment if with offending antimicrobial ASAP
- initiate empiric therapy as soon as a diagnosis of severe of complicated CDI is suspected
- Avoid use of peristaltic agents
preferred initial CDI episode treatment
fidaxomicin
alternative initial CDI episode treatment
vanc
first CDI recurrence preferred treatment
fidaxomicin
first CDI recurrence alternative treatment
vanc
adjunctive treatment first CDI recurrence and when to use
Bezlotoxumab administered with standard of care antiobiotics if recurrence within last 6 months
Caution for use in patients with CHF
second of subsequent CDI recurrence preferred treatment
fidaxomicin or vanc
when to undergo FMT
antibiotic treatment for at least 2 recurrences (3 CDI episods) before FMT
fulminant CDI treatment option
vanc
what is FMT
administration of fecal material containing distal gut microbiota from a healthy donor to a patient with CDI with the goal of restoring phylogenetic diversity and microbiota in a normal person
