Term
|
Definition
anaerobic Gram-Pos. spore-forming bacillus;
produces Toxin A, Toxin B, & Binary toxin;
NAP1/BI Epidemic strain --> increased virulence |
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Term
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Definition
| most common nosocomial (hospital-associated) infection of the GI tract |
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Term
| Patient-Related Risk Factors for C. difficile Infection |
|
Definition
advanced age;
recent surgery (especially of GI tract);
NG tube feedings;
immunocompromised - HIV/AIDS, solid organ transplant, DM, malignancy; |
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Term
| Facility-Related Risk Factors for C. difficile Infection |
|
Definition
prolonged hospitalization;
admission to ICU;
contact with infected patient; |
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Term
| Medication-Related Risk Factors for C. difficile Infection |
|
Definition
gastric acid suppression??? - H2RAs & PPIs;
ANTIBIOTICS - #1, usually broad-spectrum |
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Term
| Asymptomatic C. difficile Infection |
|
Definition
pt mounts adequate immune response and no disease manifestations are seen;
- MOST cases, Tx NOT recommended; |
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Term
| Antibiotic-associated Diarrhea |
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Definition
may be mild-to-moderate in presentation;
- 3 to 4 loose watery stools per day;
subsides with D/C of antibiotics; |
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Term
|
Definition
classic presentation --> appearance of yellow, raised plaques throughout colon;
loose, watery stools;
low-grade fever;
leukocytosis;
+/- abdominal pain/tenderness; |
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Term
|
Definition
most severe presentation;
toxic megacolon;
colectomy;
sepsis --> death; |
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Term
| Goals of C. difficile Infection Treatment |
|
Definition
resolution of symptoms;
prevent spread of disease;
prevent complications - dehydration, electrolyte abnormalities; |
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Term
| Non-Pharm Treatment of C. difficile Infection |
|
Definition
Stop offending antibiotic if possible;
Avoid anti-peristaltic medications (opioids, anti-diarrheals);
Monitor fluid status & electrolyte abnormalities;
Infection control - contact isolation, cohort patients or single room; |
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Term
| Treatment of Initial Mild-to-Moderate C. difficile Infection |
|
Definition
| If WBC < 15,000 & SCr < 1.5, use Metronidazole (Flagyl) 500 mg PO q8 hrs x 10 days; |
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Term
| Treatment of Initial Severe C. difficile Infection |
|
Definition
If WBC >= 15,000 & SCr >= 1.5;
Use vancomycin 125 mg PO q6 hr x 10 days;
Restricted use is thought to help prevent vancomycin resistant enterococcus (VRE) |
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Term
| Treatment of Fulminant Colitis |
|
Definition
Colectomy;
Combination therapy -
vancomycin 500 mg PO q6 hrs
PLUS
metronidazole 500 mg IV q8 hrs
+/-
vancomycin enema |
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Term
| Relapse of C. difficile Infection |
|
Definition
same organism causing infection;
generally must occur within 14 days of initial infection |
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Term
| Re-infection of C. difficile Infection |
|
Definition
new strain causing infection;
generally occurs after 14 days of initial infection |
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Term
| Treatment of First Recurrence of C. difficile Infection |
|
Definition
Treat with initial regimen:
metronidazole 500 mg PO q8 hrs x 10 days
OR
vancomycin 125 mg PO q6 hr x 10 days |
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Term
| Treatment of Multiple Recurrences of C. difficile Infections |
|
Definition
Vancomycin (if not used as initial therapy) using taper dosing or pulse dosing
+/-
rifampin 600 mg PO BID
+/- toxic binders (cholestyramine or tolevamer) |
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Term
|
Definition
| highly effective non-pharm treatments of multiple recurrences of C. difficile infections |
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Term
|
Definition
restores normal colonic flora;
due to risk of fungemia --> not currently recommended for multiple recurrences;
Use only for acute infection or refractory infection |
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Term
|
Definition
non-inferior to metronidazole;
not routinely used for treatment of multiple recurring C. difficile infections |
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Term
| Prevention of C. difficile Infections |
|
Definition
Handwashing --> soap & water more effective than alcohol gel;
Contact isolation --> gloves & gowns, isolate pt or cohorting pt;
Decontamination --> rooms disinfected with diluted bleach;
Vaccine in development --> introduce non-toxigenic strain to build immunity |
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