C.difficile

Question 1

What is c.difficile

Answer 1

Anaerobic, gram +, spore forming bacteria
Commonly found in guts of healthy people and doesnt cause any symptoms

Question 2

What causes c.difficile infection

Answer 2

Braod spectrum antibitoics wiping out ‘good bacteria’ so c.difficle divides out of control and toxin increase makes sick

Question 3

Why is c.difficile more common in hospital

Answer 3

Spreads between patiients
Wont affect healthy people, will affecthopsutal paitetns
Spores of c.diff are v virulent and have v long [eriod where can infect

Question 4

Risk factors for c.difficile

Answer 4

Broad spectrum anitbiotic use eg fluoroquinolones, cephalosporins, clindamycin
Acid supressing medications eg PPIs
Increasing age
Hospitalisation
Underluing morbidiity esp immunosupression
IBD
C.difficile strains eg 027 cause more severe disease
Exposure to other patients with c.difficile and/or contaminated environmetn

Question 5

Symptoms of c.difficle disease

Answer 5

Mild self limiting diarrhoea
Pseudomembranous colitis
Toxic megacolon
Perforation and death

Question 6

Indicators of disease severity in C.difficille

Answer 6

WCC >15
Acutely rising serum creatinine - AKI
Fever >38.5
Evidence of severe colitis - clinical, radiological changes

Question 7

Treatment for C.difficile mild to mod disease

Answer 7

Metronidazole oral or IV 10-14 dyas TDS PO
Barrier nurse in side room - enteric precautions, deep clean after discharge

Question 8

How treat severe or recurring C.difficile

Answer 8

Vancomycin - PO only
Faecal transplant in recurrent disease (donor stool by NG tube or NJ tube or infusion in colonsocopy -> faecal microbiota tablets)

Question 9

Why dont give vacomycin IV in c.difficile

Answer 9

Doesnt cross bowel wall -
Only oral used for C.diff
IV if systemic infection (oral wont be absorbed into blood stream)

Question 10

Life threatening C.difficle treatment

Answer 10

IVIG w combo of IV metronidazole, oral vancomycin and +/- surgical management

Question 11

Complications of c.difficile

Answer 11

Dehydration, AKI, electrolyte imbalance
Pseudomembranous colitis, toxic megacolon, colonic perforation, peritonitis
May require colectomy esp if perforation

Question 12

Diagnosing C difficile

Answer 12

Stool saple - GDH, PCR, toxin test
Results - not detected, carrier, toxin detected

Question 13

Preventign C.difficle

Answer 13

Adress risk factors - antimicrobial stewardhip, review PPI/H2 antagonists ESP if on antibiotics
Infection control
Antibiotic stewardship