Clostridium difficile infection

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Clostridium difficile is an obligately anaerobic, gram-positive, spore-forming bacillus

-The spore form is ubiquitous in the hospital environment

-it produces two exotoxins (A and B) that adhere to intestinal epithelial cells, causing cell death and disruption of cytoskeleton signal transduction 

-Risk factors include older age, comorbidities, hospitalization, antibiotics, proton pump inhibitors  

-it is the most common healthcare–associated infection in the United States

-it is the single most common cause of infectious diarrhea among all hospitalized patients, including those in the ICU

-Most cases of C. ­difficile caused by antibiotics given in the hospital develop after hospital discharge

-the route of transmission for C difficile is primary person to person by fecal-oral spread. 

-Almost any antibiotic can cause this infection, but it is most frequently associated with clindamycin, penicillins, fluoroquinolones, and cephalosporins

 

Symptoms & Signs 

Based on severity: Abdominal pain, diarrhea, foul-smelling, greasy, and green color stools, fever, leukocytosis, obstipation, bowel obstruction, fulminant colitis, toxic megacolon 

 

Diagnosis 

Detection of toxin-producing C.difficile by Enzyme immunoassay (EIA) tests, Nucleic Acid Amplification (NAA) testing, real-time polymerase chain reaction (RT-PCR)

Endoscopy: raised yellow or white plaques (pseudomembranes

 

Treatment 

-Prevention by hand hygiene, contact precautions 

-cessation of the inciting antibiotic as soon as possible

-Hydration

-Avoidance of antiperistaltic agents and opiates 

-Vancomycin, fidaxomicin, metronidazole 

-Pulsed-treatment and fecal transplant 

-Toxic megacolon: Colectomy 

 

  1. What is the single most common cause of gastrointestinal infection among hospitalized patients? C. difficile
  2. What is the most common manifestation of C.difficile? Diarrhea 
  3. What is the most sensitive test to detect CDI? stool culture for C difficile