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bacteria shizz > IC17 C Diff infection > Flashcards

IC17 C Diff infection Flashcards

1
Q

What feature of C Diff bacteria allows it to stay in our environment for very long even despite disinfection?

A

C diff forms spores

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2
Q

What does C Diff bacteria produce?

A

toxins A & B

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3
Q

What is the route of transmission of C Diff?

A

fecal oral

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4
Q

What are the risk factors for CDI?

A
  1. use of abx
  2. acid suppression therapy
  3. history of CDI
  4. GI surgery
  5. tube feeding
  6. residence in nursing homes & long term care facilities
  7. old age >65
  8. immunosuppression
  9. multiple/severe comorbidities
  10. prior hospitalization in the past 1 year
  11. prolonged hospitalization
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5
Q

What antibiotics are associated with higher CDI risk?

A
  1. clindamycin
  2. cephalosporins (3rd & 4th gen)
  3. fluoroquinolones
  4. amox-clav (BLI component)
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6
Q

What antibiotics have protective effects against CDI?

A

Doxycycline/tigecycline

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7
Q

Why do they have protective effects against CDI?

A
  1. active against C Diff
  2. inhibit toxin production
  3. minimal effects on gut microbiome
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8
Q

What are the steps for infection control for CDI?

A
  1. isolation
  2. practice hand and personal hygiene (wear PPE [gloves & gown], handwash with soap & water > alcohol handrub)
  3. environmental sanitation w sporicidal agents
  4. antimicrobial stewardship
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9
Q

What is the ONE symptom that CDI always present with?

A

watery diarrhoea (≥3 loose stools in 24h)

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10
Q

What are the risk classifications of CDI?

A
  • mild
  • moderate
  • severe
  • fulminant
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11
Q

What are the symptoms of mild CDI?

A
  • Diarrhoea
  • Abdominal cramps
    (No systemic signs of infection)
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12
Q

What are the symptoms of moderate CDI?

A
  • Diarrhoea
  • Abdominal cramps & distension
  • Fever
  • Nausea
  • Malaise
  • Leukocytosis (elevated WBC)
  • Hypovolemia
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13
Q

What are the symptoms of severe CDI?

A
  • Diarrhoea
  • Diffused abdominal cramps & distention
  • Fever
  • WBC ≥15 or SCr ≥133
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14
Q

What are the symptoms of fulminant CDI?

A
  • Hypovolemia/shock
  • Ileus (no more peristalsis)
  • Megacolon (become v large)
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15
Q

What are the diagnostic criteria for CDI?

A

A + B

A
- diarrhoea (≥3 loose stools in 24h)
- radiographic evidence of toxic megacolon/ileus

B
- positive stool test for C Diff/toxins
- colonoscopic/histopathologic evidence of pseudomembranous colitis

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16
Q

When do we perform stool test?

A

ONLY for symptomatic patients (ie. have diarrhoea)

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17
Q

What do we need to look out for when performing stool test?

A

prior laxative use 48h before test

18
Q

What is the minimum duration before we can repeat stool test?

A

7 days

19
Q

Do we repeat stool test to determine if the patient is cured of CDI?

A

NO

20
Q

What are the antibiotics available for use for the first episode of CDI?

A
  1. Vanco
  2. Fidaxomicin
  3. Metronidazole
21
Q

What is the definition of non-severe (ie. mild to moderate) CDI?

A
  1. diarrhoea
  2. positive stool test
  3. WBC <15 AND SCr <133 umol/L
22
Q

What antibiotics (& what formulation) can we use for non-severe CDI?

A

first line:
PO vanco
PO fidaxomicin

alternative:
PO metronidazole

23
Q

What is the definition of severe CDI?

A
  1. diarrhoea
  2. positive stool test
  3. WBC ≥15 OR SCr ≥133 umol/L
24
Q

What antibiotics (& what formulation) can we use for severe CDI?

A

PO vanco
PO fidaxomicin

25
Q

What is the definition of fulminant CDI?

A
  1. diarrhoea
  2. positive stool test
  3. hypovolemia OR ileus OR megacolon
26
Q

What antibiotics (& what formulation) can we use for fulminant CDI?

A

IV metronidazole + PO/PR vanco

27
Q

What is the dose of oral fidaxomicin used for initial episode of non-severe AND severe CDI?

A

200mg BD

28
Q

What is the dose of oral vanco used for initial episode of non-severe and severe CDI?

A

125mg QDS

29
Q

What is the dose of PO & PR vanco used for initial episode of fulminant CDI?

A

500mg QDS
(same dose for PO & PR)

30
Q

Wha is the dose of PO metronidazole used for initial episode of non-severe CDI?

A

400mg TDS

31
Q

What is the dose of IV metronidazole used for initial episode of fulminant CDI?

A

500mg Q8h
(technically is also TDS)

32
Q

What is the duration of treatment for the initial episode of CDI?

A

10 days
14 days if symptoms have not completely resolved

33
Q

What is the definition of recurrent CDI?

A

symptoms of CDI resolved, and subsequently reappeared after treatment has been discontinued

34
Q

What are the risk factors for CDI recurrence?

A
  1. administration of abx during/after initial treatment
  2. continued use of PPIs
  3. defective humoral immune response against C Diff (cannot produce Abs against toxin)
  4. old
  5. severe underlying disease
35
Q

What do we use for the FIRST recurrence of CDI if vanco/fidaxomicin was used for the first episode?

A

still use vanco/fidaxomicin

36
Q

What is the dosing regimen of vanco for the first recurrence of CDI assuming vanco was used for the first episode?

A

tapered/pulsed

37
Q

What is the dose & dosing regimen of fidaxomicin for the first recurrence of CDI assuming vanco/fidaxomicin was used for the first episode?

A
  1. PO 200mg BD x 10 days
  2. PO 200mg BD x 5 days –> 200mg EOD x 20 days
    (same dose of 200mg as for first ep)
38
Q

What do we use for the FIRST recurrence of CDI if metronidazole was used for the first episode?

A

vanco

39
Q

What is the dose & dosing regimen of vanco for the first recurrence of CDI assuming metronidazole was used for first episode?

A

125mg QDS x 10 days
(same dose as for non-severe and severe CDI)

40
Q

How long does it take for CDI symptoms to resolve?

A

10 days

41
Q

What if symptoms have not resolved by that duration?

A

extend treatment by another 4 days

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