C.diff Flashcards
What type of organism is Clostridioides difficile?
Gram positive rod
C. difficile is often encountered in hospital practice.
What syndrome is caused by the exotoxin produced by C. difficile?
Pseudomembranous colitis
The exotoxin causes intestinal damage.
What leads to the development of C. difficile infections?
Suppression of normal gut flora by broad-spectrum antibiotics
Clindamycin was historically associated, but the aetiology has changed.
Which antibiotics are now the leading cause of C. difficile infections?
Second and third-generation cephalosporins
This represents a significant evolution in the causes of C. difficile.
Name a non-antibiotic risk factor for C. difficile infection.
Proton pump inhibitors
Other than antibiotics, these are a significant risk factor.
What is the pathophysiology of C. difficile?
Anaerobic gram-positive, spore-forming, toxin-producing bacillus
It transmits via the faecal-oral route.
What are the two exotoxins released by C. difficile?
Toxin A and toxin B
These toxins act on intestinal epithelial cells and inflammatory cells.
What are common features of C. difficile infection?
- Diarrhoea
- Abdominal pain
- Raised white blood cell count (WCC)
- Toxic megacolon (if severe)
These features are characteristic of the infection.
How is C. difficile infection diagnosed?
By detecting C. difficile toxin (CDT) in the stool
Antigen positivity indicates exposure, not current infection.
What is the first-line therapy for the first episode of C. difficile infection?
Oral vancomycin for 10 days
This is the recommended treatment.
What is the second-line therapy for the first episode of C. difficile infection?
Oral fidaxomicin
This is used if the first-line therapy is not effective.
What is the management for recurrent episodes of C. difficile infection within 12 weeks of symptom resolution?
Oral fidaxomicin
Recurrence occurs in about 20% of patients.
What treatment is recommended for life-threatening C. difficile infections?
Oral vancomycin AND IV metronidazole
Specialist advice may lead to considering surgery.
What is bezlotoxumab?
A monoclonal antibody targeting C. difficile toxin B
NICE does not support its use for preventing recurrences due to cost-effectiveness.
What is a potential therapy for patients with 2 or more previous episodes of C. difficile infection?
Faecal microbiota transplant
This may be considered for recurrent infections.
What isolation measures should be taken for patients with C. difficile infection?
Isolation in a side room until no diarrhoea for 48 hours
Types 5-7 on the Bristol Stool Chart indicate significant diarrhoea.
What precaution should staff take when dealing with C. difficile patients?
Wear disposable gloves and an apron
Essential during any contact with patients known to have C. difficile.
True or False: Alcohol gel is effective against C. difficile spores.
False
Hand washing is essential to kill the spores.
