C.diff

Question 1

c. diff classification

Answer 1

GP spore forming anaerobe

Question 2

what exotoxins do c. deff produce

Answer 2

Toxin A and thin B
PCR detects B

Question 3

symptoms

Answer 3

water diarrhea, abdominal pain, nausea, leukocytosis, fever

Question 4

severe disease can lead to

Answer 4

pseudomembranous colitis and death

Question 5

risk factors

Answer 5

prolong hospitalization or healthcare exposure
antibiotic exposure
gastric acid suppression (PPI/H2r antagonist)
immunosuppression (chemo/hiv)
advanced age
female

Question 6

what antibiotics are high risk
(broad)

Answer 6

3rd/4th gen cephalosporins
clindamycin
fluroquinolones
carbapenems

Question 7

moderate risk antibiotics

Answer 7

broad spectrum penicillins
1st-2nd gen cephalosporin
TMX/SMX
macrolides

Question 8

low risk abx

Answer 8

aminogycosides
tetracycline
pencilins
chloramphenicol
daptomycin
tigecycline

Question 9

elevated gastric pH allows

Answer 9

c.diff spores to germinate into vegetation toxigenic cells

Question 10

diagnosis

Answer 10

> =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)

Question 11

mild or moderate or severe treatment

Answer 11

fidaxomicin 200mg (Preferred) x 10 days

or vancomycin 125 mg ( alternative) x 10 days

if both not available: metronidazole 500mg x 10-14 days

Question 12

fulminant treatment
(hypertension or shock, ileus, megacolon)

Answer 12

vancomycin 500mg + Metronidazole 500mg

10-14 days

Question 13

is routine combination of metronidazole and vancomycin is

Answer 13

not recommended

ONLY for fuminant c.dif episodes

Question 14

bezlotoxumab

Answer 14

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

Question 15

what methods are highly likely of restoring normal microbiota to reduce recurrent CDI

Answer 15

fecal transplant or SER 109