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Clostridium difficile infection – Quick review card

Gram +ve anaerobic spore-forming bacillus Part of normal intestinal flora in 1-3 % of adults and 15 % to 20 % infants Major cause of antibiotic related diarrhoea and pseudomembranous colitis Incidence and mortality has increased in both hospital and community settings worldwide Source of infection can be endogenous ( via the carrier strains ) and exogenous through infected individuals , contaminated healthcare workers , nosocomial sources and contaminated environment Pathogenesis is by disruption of colonic flora , colonization and production of toxin A ( an enterotoxin ) and 
toxin B ( a cytotoxin ) and other putative virulence factors

 

Presence of other comorbidities as abdominal surgery , CKD , inflammatory bowel disease , immunosuppression

 

If this is a 1st episode or relapse / recurrence

Severity of infection
as per PHE this can be mild , moderate or severe or life threatening

Factors as age , frailty , comorbidities

 

seek advice promptly from a microbiologist or infectious disease specialist before commencing treatment ( a notification would generally come from the hospital to discuss the situation ) if oral route not possible seek advice from a gastroenterologist or pharmacist about alternative routes as NG tube / rectal catheter do not offer loperamide and manage fluid loss / other symptoms as for acute gastroenteritis faecal microbiota transplant – microbiologist would advice on that

 

fluids to avoid dehydration preventing spread of infection seeking medical advice if symptoms worsen

 

if symptoms do not improve / worsen if antibiotic was started and repeat stool sample do not confirm infection , stop antibiotic.

 

refer if they are severely unwell , symptoms worsen rapidly or significantly life threatening infection ( hypotension , partial or complete ileus , toxic megacolon or CT evidence of severe disease they are at high risk of complications or recurrence

REFERENCES

  1. Clostridioides difficile infection: antimicrobial prescribing NICE guidelines 199 July 2021 Recommendations | Clostridioides difficile infection: antimicrobial prescribing | Guidance | NICE

  2. Eze, Paul et al. “Risk factors for Clostridium difficile infections – an overview of the evidence base and challenges in data synthesis.” Journal of global health vol. 7,1 (2017): 010417. doi:10.7189/jogh.07.010417
  3. Depestel, Daryl D, and David M Aronoff. “Epidemiology of Clostridium difficile infection.” Journal of pharmacy practice vol. 26,5 (2013): 464-75. doi:10.1177/0897190013499521
  4. Goudarzi, Mehdi et al. “Clostridium difficile Infection: Epidemiology, Pathogenesis, Risk Factors, and Therapeutic Options.” Scientifica vol. 2014 (2014): 916826. doi:10.1155/2014/916826

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