C. diff
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| What 2 organizations have treatment guidelines for C. diff | IDSA
ACG (American College of Gastroenterology)
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| 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
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| What is the most important, non-modifiable risk factor | Age 65 or older
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| What is the most important, modifiable risk factor | Antibiotic use/exposure
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| 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
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| Diagnosis of CDI | acute onset of diarrhea w/ documented toxigenic C. diff (or its toxin) and no other documented cause
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| IDSA/ACG definition of mild-moderate CDI | diarrhea w/ no severe symptoms
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| IDSA definition of severe CDI | SCr >= 1.5x baseline
-OR-
leukocytosis >=15000
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| IDSA def of severe and complicated CDI | hypotension
shock
ileus
megacolon
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| ACG def of severe CDI | Albumin <3
-PLUS ONE-
Abdominal tenderness
(OR)
leukocytosis >=15000
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| 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
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| IDSA/ACG definition of recurrent CDI | occurs w/in 8wks of completion of therapy and is of the same severity as previous episode
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| What 3 abx are commonly used to treat C. diff? Which one is the newest? | vanco, metronidazole (Flagyl), *fidaxomicin (Dificid)*
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| 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
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| What is the treatment regimen for severe CDI | vanco 125mg po QID 10-14dys
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| 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
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| What is the pathophysiology of recurrent CDI | treatment fails to eradicate spores
treatment impairs normal flora
treatment makes patient vulnerable to another infection
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| How do you treat the 1st recurrent episode of CDI | If its the same severity, use the same regimen as the intitial treatment
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| How do you treat the 2nd recurrent episode of CDI | use a pulsed/tapered po vanco regimen
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| WHat treatment consideration should be made for a 3rd recurrent episode of CDI | fecal microbiota transplant
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| What benefit does a tapered/pulsed regimen offer | tries to kill recently germinated spores
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| Describe the IDSA's tapered/pulsed regimen | (Vanco 125mg PO):
QID x10-14dys
BID x7dys
QD x7dys
q2-3dys x 2-8wks
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| Describe the ACG's pulsed regimen | (Vanco 125mg PO):
QID x 10dys
followed by every 3 dys for 10 doses
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| What role does a pharmacist play in preventing CDI | antimicrobial stewardship:
assess de-escalation of Abx
narrow spectrum when possible
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