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GI Infections

C. diff

QuestionAnswer
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
Created by: 1450725958