Flashcards in Treatment of Clostridium difficile Infections Deck (14):
C. diff produces two toxins that are responsible for
C. diff Toxins are
Toxin A & Toxin B. NAP-‐1/027 is a very virulent strain that lacks tcdC (which normally decrease toxin production) leading to increase toxin production.
C. diff is the #1 cause of
antibiotic induced diarrhea, #1 hospital acquired infxn, #1 mortality of intestinal infxn (7x increase than all other intestinal infxn combined). Increase Severity & Mortality due to NAP-‐1/027
C. diff Risk Factors:
Antibiotic use (especially combinations w/ Clindamycin, Penicillin, Cephalosporins, Fluroquinolones), Hospitalization, Increase Age, & IBD. PPI use is NOT a riskfactor. C diff recurs more often w/ Increase Age, & AAs
C. diff Diagnosis:
Clinical suspicion, presence of risk factors, Immuno-‐assays (for toxinA/B)
C. diff Tx:
Newer drugs are increase $ but C diff is a very expensive dz in the US (5billion/yr
$ DOC for mild dz, Nausea, Metallic taste, Per. Neuropathy, Not for pregnancy (Crosses placenta/breast milk).
$$ DOC for severe/recurrent/ pregnant dz. Can be given rectally if needed.
$$$ Macrolide, Inhs RNA polymerase, limited effect on normal flora or G-negative in GI tract, No cross resistance w/ other antimicrobials, minimal systemization (stool elimination), GI AEs (similar to vanc). Better than Vanc!
Putting someone’s poop in someone else’s colon… The donor gets loperamide to keep the donor poop up there for a while. Clinical trial showed it to be pretty efficacious (especially when done in lower GI). No AEs.
is an ultra-broad spectrum injectable antibiotic. It is a beta-lactam & belongs to the subgroup of carbapenem:
Meropenem: Adverse effects.
One study showed Clostridium difficile associated diarrhea (CDAD) happened in 3.6% of the patients on meropenem.
is a semi-synthetic broad-spectrum cephalosporin antibiotic.