Podcast #167 - 10 Things to Remember with C. difficile Infections

Back by popular demand we have enough podcast to cover 10 important pearls about a particular topic and this one comes from a recently published BMJ article covering Clostridioides difficile (formerly known as Clostridium difficile).

You can find the full #FOAMed (Free and Open Access Medical Education) clinical review article here at the BMJ's website titled "Clostridioides difficile: diagnosis and treatments" and with the lead author of Benoit Guery.

1.  Fulminant life-threatening colitis is rare but serious.

• Shock, ileus, and megacolon occur in less than 5% of all cases.
• Mortality rate is 35-50% in this group though. 

2.  Keep recurrence in the differential.

• Recurrence in the first two months occurs in 15-25% of patients after the first episode.
• An episode of recurrence increases the likelihood of subsequent recurrence.

3.  Asymptomatic colonization does exist.

• This is present in 4-15% of healthy adults.
• It is detected by shedding of the spores.
• Colonization can either be transient or persistent.

4.  Consider the possibility of community-acquired infection.

• More than 25%    of cases are community-acquired.
• This can affect atypical patients such as those that are younger or do not have recent antibiotic use.
• The numbers may be under recognized due to lack of screening.

5.  When to test:

• Patients with diarrhea in a healthcare setting.
• Negative results for usual GI pathogens.
• Inflammatory colitis and enteral nutrition has been ruled out.

6.  Do NOT test:

• Laxatives in the past 48 hours.
• No diarrhea (defined 3 or more unformed stools in 24 hours)
• Diarrhea has also been defined as 3 or more unformed stools for at least two consecutive days.
• Patients less than a year   old (often associated with asymptomatic colonization).

7.  Only test unformed stools.

• Defined as stools taking the shape of the container or Bristol stool types 5 to 7.
• Avoids positive result of someone asymptomatically colonized.

8.  Do NOT perform test of cure after treatment.

• Spores/toxins are detectable in 7% of patients post treatment.
• Up to 56% have a positive stool culture 1-4 weeks post-treatment despite symptom resolution.

9.  Treat with vancomycin or fidaxomicin in mild and severe disease.

• Metronidazole has lower efficacy and isno longer recommended.
• If severe infection consider tigercycline as adjunct to vancomycin.

10.  If recurrent disease off fecal transplantation.

• Evidence has demonstrated great efficacy.
• Methods of performing this procedure varies.

Let us know what you think by giving us feedback here in the comments section or contacting us on Twitter or Facebook.  Remember to look us up on Libsyn and on iTunes.  If you have any questions you can also comment below, email at thetotalem@gmail.com, or send a message from the page.  We hope to talk to everyone again soon.  Until then, continue to provide total care everywhere.

podcast_167.mp3
File Size:	11261 kb
File Type:	mp3

Download File

---