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Clostridioides Difficile Infection Flashcards

(44 cards)

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1
Q

Gram stain of Clostridioides difficile

A

Gram positive bacillus
Anaerobic
Spore forming

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2
Q

Why does use of some antibiotic increase susceptibility to Clostridioides difficile infection?

A
  • They alter + supress healthy normal intestinal micro flora competing for space
  • Allows proliferation of Clostridioides difficle + toxin production
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3
Q

What antibiotic is are associated with increased susceptibility to Clostridioides difficile colitis?

A

4Cs:
- cephalosporins e.g. ceftriaxone
- ciprofloxacin (+ other fluoroquinolones)
- clindamycin
- carbapenems e.g. meropenem

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4
Q

What does a Clostridioides difficle infection cause?

A

Antibiotic associated diarrhoea + colitis

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5
Q

What can inhibit the growth of Clostridioides difficile?
Why?

A

Oxygen
C. Difficile is a anaerobic bacteria

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6
Q

Transmission of Clostridioides difficile

A

Spore transmission
Spore forming bacteria

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7
Q

Why can Clostridioides difficle survive for a long time?

A

Spore forming bacteria
Spores are resistant to heat, acid + antibiotics

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8
Q

Why does good hand hygiene + regular glove use disruption Clostridioides difficile transmission?

A

Spores can be transferred to patients via hands of healthcare personnel
Reduces spread

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9
Q

What is the main protective barrier against Clostridioides difficle?

A

Normal intestinal micro flora

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10
Q

What types of toxins does Clostridioides difficle produce?

A

A+B

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11
Q

What type of toxin is toxin A from Clostridioides difficle?

A

Enterotoxin

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12
Q

What type of toxin is toxin B from Clostridioides difficle?

A

Cytotoxin

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13
Q

What does toxin A from Clostridioides difficle do?

A

Causes excessive fluid secretion&raquo_space; diarrhoea
Stimulates an inflammatory response&raquo_space; colitis
Has some effect of damaging cell structure

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14
Q

What does toxin B from Clostridioides difficle do?

A

Damages protein synthesis + cell structure

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15
Q

Risk factors associated with Clostridioides difficle infection

A

Antibiotic exposure
Older age
Hospitalisation
Immune suppression
Inflammatory bowel disease

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16
Q

When should a diagnosis of Clostridioides difficile colitis be suspected?

A
  • Any patient with diarrhoea
  • Received antibiotics in previous 3 months
  • Recent hospitalisation and/or diarrhoea within 48 hours after hospitalisation
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17
Q

Investigation + diagnosis of C difficile

A
  • stool samples
  • tested for C difficile antigen (glutamate dehydrogenase)
  • if positive > + A+B toxins by PCR or enzyme immunoassay
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18
Q

What are the stages of Clostridioides difficile infection?

Study These Flashcards
A
  • mild: normal WCC
  • moderate: raised WCC <15x10^9, 3-5 loose stools per day
  • severe: raised WCC >15x10^9, acutely raised creatinine, temp >38.5, evidence of severe colitis
  • life threatening: hypotension, partial or incomplete ileus, toxic megacolon
19
Q

mild C difficile infection

20
Q

moderate C difficile infection

Study These Flashcards
A
  • raised WCC <15x10^9
  • 3-5 loose stools per day
21
Q

severe C difficile infection

Study These Flashcards
A
  • raised WCC >15x10^9
  • acutely rasied creatinine >50% baseline
  • temp >38.5
  • evidence of severe colitis
22
Q

life threatening C difficile infection

Study These Flashcards
A
  • hypotension
  • partial or complete ileus
  • toxic megacolon
23
Q

What is used to assess the severity of C.difficile infection?

Study These Flashcards
A

white blood cell count

24
Q

What tests are done on stool samples?

Study These Flashcards
A

Enzyme immunoassay (EIA)
PCR

25
What are EIAs used for in diagnosis of Clostridioides difficle infection?
Glutamate dehydrogenase produced by C.difficile Detecting toxins A + B
26
What are PCR assay used for in diagnosis of Clostridioides difficle infection?
Toxin gene
27
What is the aim of tests for Clostridioides difficile?
Identify C.difficile bacteria Presence of toxin
28
General management of C difficile
- stop antibiotics - stop PPIs - stop loperamide (anti-diarrhoeals) - isolation in side room until no diarrhoea for 48 hours - use of disposable aprons + gloves when in contact with patient - hand washing
29
Why should loperamide be stopped in C diff infection?
- masks the symptoms - increased toxic mega colon risk
30
Treatment of mild Clostridioides difficile infection without fever, abdominal pain or leucocytosis
Cessation of antibiotics
31
Treatment of first episode of Clostridioides difficile infection
- first line: **oral vancomycin for 10 days** - second line: oral fidaxomicin - third line: oral vancomycin +/- IV metronidazole
32
Treatment of life threatening Clostridioides difficile infection
Oral *vancomycin* AND IV *metronidazole*
33
treatment of recurrent episode of C difficle
- within 12 weeks of symptom resolution: oral *fidaxomicin* - after 12 weeks: oral *vancomycin* or *fidaxomicin*
34
Why is *vancomycin* used to treat of mild severe, complicated Clostridioides difficile infection over *metronidazole*?
Produces faster symptom resolution Fever treatment failures
35
Treatment for relapse infection of Clostridioides difficile
Investigational therapies Faecal microbiota transplantation to repopulate gut flora Oral fidaxomicin
36
Prevention of Clostridioides difficile infection
Careful use of antimicrobial agents - educate Emphasise importance of hand washing Isolate if CDI suspected Wear PPE when visiting CDI patients Clean surfaces
37
Why is hand washing better at preventing Clostridioides difficile infection than hand gel?
Alcohol does not kill C.difficile spores
38
Drugs used against Clostridioides difficile infection
*Vancomycin* *Fidaxomicin*
39
What is faecal microbiota transplantation?
Transfer of stool from healthy donor to patient with CDI to reconstitute normal gut microbial flora
40
Risk of faecal microbiota translpantation
Transmission of HIV, hepatitis + retrovirus
41
Virulence factor of Clostridioides difficile
Enterotoxin A Cytotoxin B
42
What antibiotics is the leading cause of C. difficile
Cephalosporins
43
What does C. difficile antigen suggest?
Shows exposure to bacteria, not current infection
44
Complications of C diff infection
pseudomembranous colitis toxic megacolon

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