C-Diff

Question 1

Pathophysiology

Answer 1

• Anaerobic Gram positive bacilli - found in gut when the normal gut flora are suppressed by broad-spec Abx

Produces an exotoxin which causes pseudomembranous colitis.

Question 2

Most common cause of C-Diff

Answer 2

Broad spec Abx

Second and third-generation cephalosporins are now the leading cause

Question 3

Other than antibiotics what other drug can increase the risk of C Diff

Answer 3

PPI

Question 4

How is C-Diff transmitted

Answer 4

via the faecal-oral route by ingestion of spores

Question 5

Features of C-Diff

Answer 5

diarrhoea
abdominal pain
a raised white blood cell count (WCC) is characteristic
if severe, toxic megacolon may develop

Question 6

Describe the difference between Moderate, Severe and Life-threatening C-Diff

Answer 6

Moderate
- WCC <15
- 3-5 loose stools per day

Severe
- WCC >15
- raised creatinine
- fever
- radiological evidence severe colitis

Life-threatening
- Hypotension
- Partial or complete ileus
- Toxic megacolon

Question 7

What investigation is needed for a diagnosis of C-Diff

Answer 7

detection of toxin in the stool

Question 8

Management of C-DIff

Answer 8

Mild infection - IV Metronidazole
Severe infection - oral vancomycin
Life-threatening = Oral vancomycin and IV metronidazole

Question 9

What percentage of patients have recurrence of C-Diff?

Answer 9

Recurrent in around 20%

(increasing to 50% after second episode)

Question 10

How is recurrent C-Diff treated?

Answer 10

within 12 weeks of symptom resolution:
> oral fidaxomicin

after 12 weeks of symptom resolution:
> oral vancomycin OR fidaxomicin