C.Difficile infection

Question 1

About C.Difficile infection?

Answer 1

Clostridioides difficile is aGram positive rodoften encountered in hospital practice. It produces an exotoxin which causes intestinal damage leading to a syndrome called pseudomembranous colitis.

C. difficile develops when the normal gut flora are suppressed by broad-spectrum antibiotics.

Other than antibiotics, risk factors include:
- proton pump inhibitors

Question 2

Leading cause of C diff?

Answer 2

2nd and 3rd generation cephalosporins

Question 3

Clinical presentation?

Answer 3

• diarrhoea
• abdominal pain
• araised white blood cell count (WCC)is characteristic
• if severe toxic megacolon may develop

Question 4

Life-threatening presentation?

Answer 4

hypotension

partial or complete ileus

toxic megacolon, or CT evidence of severe disease

Question 5

Severe presentation?

Answer 5

• High WCC (>15 x 10^9/L) or an acutely high creatinine (>50% above baseline)

or a temperature > 38.5

or evidence of a severe colitis (abdominal or radiological signs)

Question 6

Moderate c diff infection?

Answer 6

high WCC (but less than 15 x 10^9/L)

typically 3-5 loose stools per day

Question 7

Mild c diff infection?

Answer 7

normal WCC

Question 8

Treatment of C diff infection? (first episode)

Answer 8

Current antibiotic therapy should be reviewed and antibiotics stopped if possible.

First episode of C. difficile infection

• first-line therapy isoral vancomycinfor 10 days
• second-line therapy:oral fidaxomicin
• third-line therapy:oral vancomycin +/- IV metronidazole

Question 9

treatment of a recurrent episode of C.diff?

Answer 9

• recurrent infection occurs in around 20% of patients, increasing to 50% after their second episode
• within 12 weeks of symptom resolution: oral fidaxomicin
• after 12 weeks of symptom resolution: oral vancomycin OR fidaxomicin

Question 10

treatment of life-threatening C.diff infection

Answer 10

• oral vancomycin AND IV metronidazole
• specialist advice - surgery may be considered

Question 11

Other therapies for the treatment of C.diff infection?

Answer 11

• bezlotoxumabis a monoclonal antibody which targetsC. difficiletoxin B
  
  • NICE do not currently support its use to prevent recurrences as it is not cost-effective
• faecal microbiota transplant
  • may be considered for patients who’ve had 2 or more previous episodes