Cl.Difficle

Question 1

Risk factors

Answer 1

• Age > 65 years
• Prolonged hospital stay
• Immunosuppressed patients (HIV, DM, Corticosteroid administration, Chemotherapy)
• Colonic disease (IBD)
• Antibiotics (the most common antibiotics are Clinda, Cephalosporin (2nd, 3rd generation), quinolones)

Question 2

Diagnosis

Answer 2

1-Stool Culture is the Golden Standard to run tests! (and it takes up to 4 days)
2-PCR for Cl. difficile toxin A, B
3-Enzyme immunoassay “EIA” for Cl. difficile toxin A,
4- EIA “Enzyme immunoassay” for Cl. difficile glutamate dehydrogenase (GDH)
5-CBC
6- Endoscopy : Pseudomembranous Colitis

Question 3

Treatment

Answer 3

1-Stop the offending antibiotics
2-Mild to moderate cases:
* Vancomycin oral 125mg / 6h for 10 days
Or Metronidazole oral 500mg oral / 8h for 10 days
3-Severe cases
Vancomycin oral 500mg /6h for 10 days
+
Metronidazole 500mg IV q 8h for 10 days

Question 4

Complications

Answer 4

Toxic megacolon
Perforation
Peritonitis
Hypovolemic shock

Question 5

The following are important in the differential diagnosis of Clostridium difficile-associated disease EXCEPT?
A. Leptospirosis.
B. Toxic megacolon.
C. Giardia gastroenteritis.
D. Inflammatory bowel disease.

Answer 5

A