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GI Infections
C. diff
| Question | Answer |
|---|---|
| What 2 organizations have treatment guidelines for C. diff | IDSA ACG (American College of Gastroenterology) |
| What is the pathophysiology of C. diff infection (CDI) | 1. abx therapy initiated 2. disruption of normal flora 3. C. diff exposure, colonization, and overgrowth 4. Release of Toxin A - fluid accumulation in bowel, Release of Toxin B - disseminates throughout damaged gut wall 5. Mucosal injury & inflamation |
| What is the most important, non-modifiable risk factor | Age 65 or older |
| What is the most important, modifiable risk factor | Antibiotic use/exposure |
| 10 other modifiable risk factors | meds (PPI, steroids) LTC resident hospitalization severe illness surface contamination hand carriage by staff Hx/exposure C. diff immunosupression GI Sx IBD |
| Diagnosis of CDI | acute onset of diarrhea w/ documented toxigenic C. diff (or its toxin) and no other documented cause |
| IDSA/ACG definition of mild-moderate CDI | diarrhea w/ no severe symptoms |
| IDSA definition of severe CDI | SCr >= 1.5x baseline -OR- leukocytosis >=15000 |
| IDSA def of severe and complicated CDI | hypotension shock ileus megacolon |
| ACG def of severe CDI | Albumin <3 -PLUS ONE- Abdominal tenderness (OR) leukocytosis >=15000 |
| ACG def severe and complicated CDI | -Any ONE of the following (due to CDI)- Admission to ICU hypotension fever >= 38.5 ileus/sig ab distension mental status changes leukocytosis >=35000 or <=2000 Serum lactate >2.2 End organ failure |
| IDSA/ACG definition of recurrent CDI | occurs w/in 8wks of completion of therapy and is of the same severity as previous episode |
| What 3 abx are commonly used to treat C. diff? Which one is the newest? | vanco, metronidazole (Flagyl), *fidaxomicin (Dificid)* |
| What is the treatment regimen for mild-moderate CDI | metronidazole 500mg po TID x 10-14dys (if pregnant, intolerant, or failed flagyl:) vanco 125mg po QID x10dys |
| What is the treatment regimen for severe CDI | vanco 125mg po QID 10-14dys |
| WHat is the treatment regimenfor sever & complicated CDI | vanco 500mg po QID -PLUS- metronidazole 500mg IV q8hrs (if ileus present:) -PLUS- vanco 500mg/500ml saline enema QID |
| What is the pathophysiology of recurrent CDI | treatment fails to eradicate spores treatment impairs normal flora treatment makes patient vulnerable to another infection |
| How do you treat the 1st recurrent episode of CDI | If its the same severity, use the same regimen as the intitial treatment |
| How do you treat the 2nd recurrent episode of CDI | use a pulsed/tapered po vanco regimen |
| WHat treatment consideration should be made for a 3rd recurrent episode of CDI | fecal microbiota transplant |
| What benefit does a tapered/pulsed regimen offer | tries to kill recently germinated spores |
| Describe the IDSA's tapered/pulsed regimen | (Vanco 125mg PO): QID x10-14dys BID x7dys QD x7dys q2-3dys x 2-8wks |
| Describe the ACG's pulsed regimen | (Vanco 125mg PO): QID x 10dys followed by every 3 dys for 10 doses |
| What role does a pharmacist play in preventing CDI | antimicrobial stewardship: assess de-escalation of Abx narrow spectrum when possible |