While Clostridium difficile (C diff) is a common infection, there is a lot to know. A thorough but brief review is a good place to test your knowledge (Clin Gastroenterol Hepatol 2012; 10: 581-92).
- a. When was C diff discovered?
- b. When was C diff identified as a cause of antibiotic-associated diarrhea?
- c. What antibiotics have been associated with a surge in severity and frequency of C diff infections?
- d. Which C diff strains are the predominant cause of severe C diff?
- e. How many C diff infections are occurring yearly in hospitalized patients in U.S.?
- f. What are the most important risk factors?
- g. How does the risk profile change for multiple antibiotics?
- h. What time of year sees the greatest number of infections?
- i. What does C diff smell like?
- j. What % of antibiotic-associated diarrhea is due to C diff?
- k. What clinical parameters may indicate severe infection and which ones indicate fulminant infection?
- l. How much does a nucleic acid amplification test (NAAT) cost compare to enzyme immunoassay (EIA)? How does this test work? What are the advantages/disadvantages?
- m. How to treat severe infection?
- n. What instructions should be given to prevent C diff in hospital?
- a. 1935
- b. 1970s
- c. Fluoroquinolones
- d. BI/NAP1/027. This strain has hypersecretion of toxins A & B, the presence of binary toxin, and resistance to fluoroquinolones.
- e. CDI present in 300,000 hospitalized patients in 2005 (vs. 85,000 in 1993)
- f. Hospitalization, older age (>65 years), and receipt of antibiotics (especially during 1st two months).
- g. Hazard ratio 2.5 for two antibiotics, HR 9.6 for exposure to five antibiotics
- h. Winter
- i. “Horse stable”
- j. 15-25%
- k. Severe: WBC>15,000, Creatinine >1.5 fold patient’s baseline. Also, albumin <2.5, admission to ICU, pseudomembranes on endoscopy, comorbid diseases. Fulminant: (50% mortality) colon >6cm in diameter/toxic megacolon, WBC >50,000, lactate >5 mmol/L.
- l. ~10 times the cost. Works by identifying genes that encode toxins by PCR or loop-mediated amplification of DNA. Test is very sensitive and rapid but may have false-positives. Some recommend using a less expensive test for screening to decrease costs.
- m. Vancomycin up to 500mg QID (NG/PO) plus metronidazole. If complete ileus, vancomycin can be given rectally
- n. Hand hygiene (not alcohol): either soap or chlorhexidine, contact precautions, cleaning environment –chlorine solutions effective (1000-5000 ppm), antimicrobial stewardship (especially reducing clindamycin and fluoroquinolones)
How many did you get right?