clostridium_difficile
Clostridium difficile
introduction
Clostridium difficile is a Gram positive, anaerobic, heat-resistant spore forming bacillus which is a common cause of antibiotic-related nosocomial colitis, and in its severe form,
pseudomembranous colitis.
it is present in 2-3% of normal adults and in 70% of healthy infants
~20% of patients who are hospitalised acquire this organism, and ~1/3rd of these develop diarrhoea.
it should be suspected as the cause of diarrhoea in any patient who has had antibiotics in the previous 2 months, or if diarrhoea develops after 72 hours of hospitalisation.
most patients recover without specific treatment, but mortality rates of up to 25% occur in the frail elderly.
pathogenic strains produce two toxins - Toxin A is an enterotoxin, while Toxin B is a cytotoxin.
a hypervirulent strain (NAP/027) has spread through Nth America and Europe since 2003, and in 2010 has reached Australia
risk factors
prevention
avoidance of unnecessary antibiotics or hospitalisation
strict adherence to infection control such as hand washing
isolate patients who are incontinent with diarrhoea
environmental cleaning with sodium hypochlorite solution
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diagnosis
rapid stool testing kits are available
the EIA tests are only 80% sensitive, thus a negative result does not exclude serious disease
the much more expensive PCR test is more sensitive
indicators of possible severe disease
age > 60 years
temp > 38.3 deg C
serum albumin < 25 g/L
peripheral WCC > 15,000 cells/microL
deteriorating renal function
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endoscopic evidence of pseudomembranous colitis or ICU Rx
subtotal colectomy performed
toxic megacolon
antibiotic Rx
clostridium_difficile.txt · Last modified: 2018/08/11 14:11 (external edit)