Definition of CDI
Unexplained diarrhea in form of 3 or more unformed stools in 24h in conjunction with positive stool test for C. diff toxins
Pathogenesis of CDI
- ) normal flora is disrupted
- ) Outside source of C. diff comes in
- ) Low [ ] of antibodies of toxin A
- ) C diff diarrhea
If age > 65 or prior antibiotic treatment –> have increased risk of recurrence
What are the symptoms of C. Diff Infection?
- ) Watery, mucous like green, foul smelling diarrhea
- ) Cramping abdominal pain
- ) Leukocytosis (> 15,000)
- In fulminant CDI - ) Hypoalbuminemia (< 2.5)
- ) Increasing Scr with renal failure (in fulminant CDI)
- ) toxic megacolon can develop
Difference between C diff infection (CDI) and antibiotic-associated diarrhea (AAD)?
Results of positive stool toxin assay
Evidence of colitis
Treatment for first episode of CDI?
Preferred: fidaxomicin
- Is expensive though
- Don’t have to give 1st
Vancomycin is good alternative
If fidaxomicin and Vancomycin is not available for non-severe CDI can give:
- metronidazole
What is considered as non-severe CDI?
WBC 15,000 or less
SCr < 1.5
What is the treatment for first reoccurrence of CDI?
Preferred: fidaxomicin
Alternative:
- vancomycin tapered/pulse therapy
- Vancomycin standard therapy (can considering giving standard if initially use metronidazole in 1st episode treatment)
Adjunctive treatment:
- Bezlotoxumab + standard care antibiotics (IF recurrence w/in last 6 months)
What patients should we not give Bezlotoxumab with?
Patients with CHF
Treatment for patients with 2nd recurrence or subsequent CDI ?
- Fidaxomicin
- Vancomycin tapered or pulsed
- Vancomycin standard dosing
- Fecal Microtobiota transplant (FMT)
- Adjunctive treatment:
- Bezlotoxumab + standard care of antibiotics (IF recurrence was in past 6 months)
When should you use fecal microbiotia transplant? (FMT)
Recommend use after at least 2 recurrences (3 CDI episodes) before using FMT
Treatment for fulminant (severe) CDI?
Vancomycin (higher dose)
If ileus is present –> add RECAL installation of PO/PR vancomycin + metronidazole
What is considered as fulminant CDI?
- Hypotension or shock
- Ileus
- Toxic megacolon
What is fecal microbiota transplantation (FMT)?
Giving fecal material from healthy donor to patient with CDI
When is FMT used in CDI?
- After 2 recurrent episodes of mild to moderate CDI
How to prevent CDI?
Good hand hygiene
Good environmental hygiene
