c diff

Question 1

define

Answer 1

Clostridium difficile

Clostridium difficile is a Gram positive rod often encountered in hospital practice.

It produces an exotoxin which causes intestinal damage leading to a syndrome called pseudomembranous colitis.

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

Clindamycin is historically associated with causing Clostridium difficile but the aetiology has evolved significantly over the past 10 years.

Second and third generation cephalosporins are now the leading cause of Clostridium difficile.

Question 2

s/s + diagnosis

Answer 2

Features

• diarrhoea
• abdominal pain
• a raised white blood cell count is characteristic
• if severe toxic megacolon may develop

Diagnosis is made by detecting Clostridium difficile toxin (CDT) in the stool

Question 3

mx

Answer 3

Management

1. first-line therapy is oral metronidazole for 10-14 days
2. if severe or not responding to metronidazole then oral vancomycin may be used
3. for life-threatening infections a combination of oral vancomycin and intravenous metronidazole should be used