Table of Contents
- 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
- broad spectrum antibiotic use
- gastric acid suppression eg proton pump inhibitors (PPIs), or gastrectomy
- prolonged hospitalisation
- renal impairment
- 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
- avoid using diclofenac non-steroidal anti-inflammatory agent as this seems to increase risk by 35% 1)
- proton pump inhibitors (PPIs) appear to almost double the risk (1.7x) 2)
- rapid stool testing kits are available
- the EIA tests are only 80% sensitive, thus a negative result does not exclude serious disease
- detect C. difficile glutamate dehydrogenase (GDH) or toxins A or B
- 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
- elevated serum lactate
- endoscopic evidence of pseudomembranous colitis or ICU Rx
- subtotal colectomy performed
- toxic megacolon
- cease aetiologic antibiotics if possible
- oral or NGT metronidazole tds for 10 days, if not tolerated, can be given iv
- it would appear the most effective Rx is a faecal transplant - faeces from a healthy donor is placed in the colon. This appears to resolve even chronic cases within 24 hours! - see news story
- severe cases may need oral or NGT (NOT iv as not effective) vancomycin 6hrly for 10 days +/- iv metronidazole tds 10 days
- see therapeutic guidelines for more detailed Mx.
clostridium_difficile.txt · Last modified: 2018/08/11 04:11 by 127.0.0.1