C.diff Flashcards
c. diff classification
GP spore forming anaerobe
what exotoxins do c. deff produce
Toxin A and thin B
PCR detects B
symptoms
water diarrhea, abdominal pain, nausea, leukocytosis, fever
severe disease can lead to
pseudomembranous colitis and death
risk factors
prolong hospitalization or healthcare exposure
antibiotic exposure
gastric acid suppression (PPI/H2r antagonist)
immunosuppression (chemo/hiv)
advanced age
female
what antibiotics are high risk
(broad)
3rd/4th gen cephalosporins
clindamycin
fluroquinolones
carbapenems
moderate risk antibiotics
broad spectrum penicillins
1st-2nd gen cephalosporin
TMX/SMX
macrolides
low risk abx
aminogycosides
tetracycline
pencilins
chloramphenicol
daptomycin
tigecycline
elevated gastric pH allows
c.diff spores to germinate into vegetation toxigenic cells
diagnosis
> =3 unformed stool in 24 hr + positive toxin test
multi step testing preferred
-GDH + toxin A/B assay
-NAAT (PCR) + toxin A/B assay (common)
mild or moderate or severe treatment
fidaxomicin 200mg (Preferred) x 10 days
or vancomycin 125 mg ( alternative) x 10 days
if both not available: metronidazole 500mg x 10-14 days
fulminant treatment
(hypertension or shock, ileus, megacolon)
vancomycin 500mg + Metronidazole 500mg
10-14 days
is routine combination of metronidazole and vancomycin is
not recommended
ONLY for fuminant c.dif episodes
bezlotoxumab
reduce recurrence of CDI in pt > 18 who RE RECIEVING antibacterial risk drug treatment and high risk or recurrence
human IgGI monoclonal
1/2 life = 19 days
what methods are highly likely of restoring normal microbiota to reduce recurrent CDI
fecal transplant or SER 109