Clostridium Difficile
Clostridium difficile
Babe Ruth
06/23/2011
Microbiology
Clostridium difficile
I. What is Clostridium difficile and why is it relevant to us? A.“Clostridium difficile (C. difficile) is a bacterium that may develop due to the prolonged use of antibiotics during healthcare treatments.” 1 B. “Clostridium difficile is an obligate anaerobe or microaerophilic, gram-positive, spore- forming, rod-shaped bacillus.” 2
II. What are the signs and symptoms of Clostridium difficile infection (CDI)? A. C. difficile can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon (pseudomembranous colitis). 3 1. Mild to moderate C. difficile infections may cause watery diarrhea 3 or more times per day for more …show more content…
than 2 days. 3 2. Mild abdominal cramping and tenderness may be present. 3 3. Severe infections may cause the colon to become inflamed (colitis) or to form patches of raw tissue that can bleed or produce pus (pseudomembranous colitis). 3 4. Other symptoms can include: a. Watery diarrhea 10-15 times per day. 3 b. Abdominal cramping and pain which can be severe. 3 c. Fever 3 d. Blood or pus in the stool. 3 e. Nausea 3 f. Dehydration 3 g. Loss of appetite. 3 h. Weight loss. 3 B. When to see a doctor 1. “Many people have loose stools after antibiotic therapy. You should see your doctor if your symptoms last more than 3 days or if you have a new fever, severe pain or cramping, blood in your stool, or more than 3 bowel movements per day.”3
III. What causes a C. difficile infection? A. C. difficile bacteria can be found almost anywhere! 2 1. Clostridium difficile bacteria can be found in soil, water, air, and human and animal feces. Some healthy people carry the bacteria as normal microbiota in their large intestine. 3 2. C. difficile is most common in hospitals and other healthcare facilities, where a much higher percentage of people carry the bacteria; at least 80% of CDI cases are related to healthcare settings. 3 B. How do the bacteria come to infect a person? 1. C. difficile bacteria are transmitted from person to person via the fecal-oral route. 2 a. Fomites are excellent carriers of this microbe because the C. difficile bacteria produce spores which can live on inanimate objects (ie. telephones, tables, bed rails) for upwards of 70 days. 2 b. If an uninfected person were to touch a contaminated surface and then ingest the bacterial spores, they could very well become infected. 3 C. Healthy people don’t usually get sick from C. difficile bacterium. 3 1. Normal microbiota are killed off by antibiotics allowing for the overgrowth of C. difficile bacteria. 3 2. The antibiotics which often lead to CDI include fluoroquinolones, cephalosporins and clindamycin. These are all broad-spectrum antibiotics. 2 3. Once the C. difficile has established itself in the colon, it can produce at least 2 exotoxins, toxin A and toxin B which can attack the lining of the intestine. 3 D. Emergence of a new strain 1. “In 2004 the emergence of a new epidemic strain of C. difficile- associated disease (CDAD) causing hospital outbreaks in several states was reported to the CDC.” 1 2. The new strain is more virulent, with abilities to produce a greater quantity of toxins A and B, and is also more resistant to previously used antibiotics. 1
IV. Risk factors for C. diff. infection include: A. Antibiotic use, especially a type of antibiotic that is broad-spectrum (is able to treat a wide variety of bacteria) or if you have been taking antibiotics for an extended period of time. 4 B. Surgery of the gastrointestinal (GI) tract 4 C. Abdominal surgery that requires moving the intestines aside 4 D. Hospitalization 4 E. Living in a nursing home or extended-care facility 4 F. Colon problems, such as inflammatory bowel disease or colorectal cancer 4 G. Weakened immune system 4 H. Previous C. diff infection 4 I. Being 65 years of age or older (10 times greater risk than younger people) 4
V. Complications of CDI or CDAD A. Dehydration with electrolyte imbalance 5 B. Perforation of (hole through) the colon 5 C. Toxic megacolon- a disorder where the infection causes rapid dilation of the colon. If rapid widening is allowed to continue, an opening (perforation) can form in the colon. Therefore, most cases of toxic megacolon will require surgery, such as colectomy (removal of the entire colon). In this case you might also be placed on antibiotics to prevent sepsis. 5 D. Colitis or Pseudomembranous colitis 3 E. If pseudomembranous colitis or toxic megacolon are left untreated- Death. 3
VI. Tests and Diagnostics related to Clostridium difficile detection A. Bacterial stool culture 1. Fresh random stool collected in a clean plastic container taken to the lab within 15-30 minutes. 6 2. “C. difficile toxins can be more rapidly identified from a stool sample using an immunochemical method than from a routine culture. These tests are not run on a specimen unless requested by the physician.” 6 B. Colon examination 1. In some cases, to help confirm a diagnosis of C. difficile infection, your doctor may examine the inside of your colon. This test (flexible sigmoidoscopy) involves inserting a flexible tube with a small camera on one end into your lower colon to look for areas of inflammation and pseudomembranes. 6 C. Imaging tests. 1. If there 's concern about possible complications of C. difficile, your doctor may order a computerized tomography (CT) scan, which provides detailed images of your colon. The scan can show a thickening of the wall of your colon, which is common in pseudomembranous colitis. 6
VII. Treatments and Drugs for CDAD A. Antibiotics 1. Metronidazole (Flagyl)- Usually the first choice of physicians. 7
. 2. Vancomycin (Vancocin)- Typically used only for severe cases. Usually prescribed on a tapered schedule for up to 7 weeks. Extremely expensive! 7 3. Fidaxomicin (Dificid)- Just approved by the FDA on 05/27/11. “Clinical response was similar to vancomycin… in some patients with CDAD, symptoms can return. In the Dificid trials, a greater number of patients treated with Dificid had a sustained cure 3 weeks after treatment ended versus those patients treated with vancomycin.” 8 B. Probiotics 1. A yeast called Saccharomyces boulardii, in conjunction with antibiotics, might help prevent recurrent C. difficile infections. 3 C. Surgery 1. For people with severe pain or organ failure related to the CDI, surgical removal of the infected portion of the colon (colectomy) may be the only option. 3 D. “Stool Transplants” 1. First, the undigested matter from the donor stool must be removed with some sort of straining device. Next the remaining fluid is spun in a centrifuge to reduce the material into a bacterial “pellet.” Finally the pellet may be introduced to the patient through a nasogastric tube, or reconstituted in liquid and inserted into the rectum in the form of an enema. 2
VIII. Prevention A. Handwashing is the single most important method of infection prevention. Soap and water have proven to be more effective at removing the bacterial spores associated with C. difficile. 3 B. Contact precautions- people who are hospitalized with C. difficile should have a private room or share a room with someone who has the same illness. Hospital staff and visitors wear disposable gloves and gowns while in the room. 3 C. Thorough cleaning of all surfaces should be carefully disinfected with a product that contains chlorine bleach. C. difficile spores can survive routine cleaning products that don 't contain bleach. 3 D. “Avoid unnecessary use of antibiotics. Antibiotics are sometimes prescribed for viral illnesses that aren 't helped by these drugs. If you do need an antibiotic, ask your doctor to prescribe one that has a narrow range and that you take for the shortest time possible.” 3
References
1.
“Frequently Asked Questions about Clostridium difficile for Healthcare Providers.” Healthcare-associated Infections. Centers for Disease Control and Prevention. 25 Nov. 2010. Web. 19 June 2011. <http://www.cdc.gov/HAI/organisms/cdiff/Cdiff_faqs_HCP.html>.
2. Lewis, Sharon L., et al. Medical-Surgical Nursing: Assessment and Management of Clinical Problems. 8th ed. St. Louis: Elsevier, 2011. Print.
3. The Mayo Clinic Staff. “C. difficile.” MayoClinic.com. Mayo Clinic for Medical Education and Research (MFMER). 03 Nov. 2010. Web. 14 June, 2011. <http://www.mayoclinic.com/health/c-difficile/DS00736>.
4. “Clostridium difficile infection.” FamilyDoctor.org. American Academy of Family Physicians. Feb. 2011. Web. 21 June 2011. <http://familydoctor.org/online/famdocen/home/common/infections/common/bacterial/939.printerview.html>.
5. Vorrick, Linda J., MD. “Pseudomembranous Colitis.” Medline Plus. U.S. National Library of Medicine. Apr. 2010. Web. 22 June 2011. <http://www.nlm.nih.gov/medlineplus/ency/article/000259.htm>.
6. Van Leeuwen, Anne M., and Debra J. Poelhuis-Leth. Davis’s Comprehensive Handbook of Laboratory and Diagnostic Tests with Nursing Implications. 3rd ed. Philadelphia: F.A. Davis Company, 2009.
Print.
7. Deglin, Judith, April Vallerand, and Cynthia Sanoski. Davis’s Drug Guide for Nurses. 12th ed. Philadelphia: F.A. Davis Company, 2011. Print.
8. Liscinsky, Morgan. “FDA approves treatment for Clostridium difficile infection.” FDA News Release. The U.S. Food and Drug Administration. 27 May 2011. Web. 21 June, 2011. <http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm257024.htm>.
Babe Ruth
06/23/2011
Microbiology
Clostridium difficile
I. What is Clostridium difficile and why is it relevant to us? A.“Clostridium difficile (C. difficile) is a bacterium that may develop due to the prolonged use of antibiotics during healthcare treatments.” 1 B. “Clostridium difficile is an obligate anaerobe or microaerophilic, gram-positive, spore- forming, rod-shaped bacillus.” 2
II. What are the signs and symptoms of Clostridium difficile infection (CDI)? A. C. difficile can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon (pseudomembranous colitis). 3 1. Mild to moderate C. difficile infections may cause watery diarrhea 3 or more times per day for more …show more content…
than 2 days. 3 2. Mild abdominal cramping and tenderness may be present. 3 3. Severe infections may cause the colon to become inflamed (colitis) or to form patches of raw tissue that can bleed or produce pus (pseudomembranous colitis). 3 4. Other symptoms can include: a. Watery diarrhea 10-15 times per day. 3 b. Abdominal cramping and pain which can be severe. 3 c. Fever 3 d. Blood or pus in the stool. 3 e. Nausea 3 f. Dehydration 3 g. Loss of appetite. 3 h. Weight loss. 3 B. When to see a doctor 1. “Many people have loose stools after antibiotic therapy. You should see your doctor if your symptoms last more than 3 days or if you have a new fever, severe pain or cramping, blood in your stool, or more than 3 bowel movements per day.”3
III. What causes a C. difficile infection? A. C. difficile bacteria can be found almost anywhere! 2 1. Clostridium difficile bacteria can be found in soil, water, air, and human and animal feces. Some healthy people carry the bacteria as normal microbiota in their large intestine. 3 2. C. difficile is most common in hospitals and other healthcare facilities, where a much higher percentage of people carry the bacteria; at least 80% of CDI cases are related to healthcare settings. 3 B. How do the bacteria come to infect a person? 1. C. difficile bacteria are transmitted from person to person via the fecal-oral route. 2 a. Fomites are excellent carriers of this microbe because the C. difficile bacteria produce spores which can live on inanimate objects (ie. telephones, tables, bed rails) for upwards of 70 days. 2 b. If an uninfected person were to touch a contaminated surface and then ingest the bacterial spores, they could very well become infected. 3 C. Healthy people don’t usually get sick from C. difficile bacterium. 3 1. Normal microbiota are killed off by antibiotics allowing for the overgrowth of C. difficile bacteria. 3 2. The antibiotics which often lead to CDI include fluoroquinolones, cephalosporins and clindamycin. These are all broad-spectrum antibiotics. 2 3. Once the C. difficile has established itself in the colon, it can produce at least 2 exotoxins, toxin A and toxin B which can attack the lining of the intestine. 3 D. Emergence of a new strain 1. “In 2004 the emergence of a new epidemic strain of C. difficile- associated disease (CDAD) causing hospital outbreaks in several states was reported to the CDC.” 1 2. The new strain is more virulent, with abilities to produce a greater quantity of toxins A and B, and is also more resistant to previously used antibiotics. 1
IV. Risk factors for C. diff. infection include: A. Antibiotic use, especially a type of antibiotic that is broad-spectrum (is able to treat a wide variety of bacteria) or if you have been taking antibiotics for an extended period of time. 4 B. Surgery of the gastrointestinal (GI) tract 4 C. Abdominal surgery that requires moving the intestines aside 4 D. Hospitalization 4 E. Living in a nursing home or extended-care facility 4 F. Colon problems, such as inflammatory bowel disease or colorectal cancer 4 G. Weakened immune system 4 H. Previous C. diff infection 4 I. Being 65 years of age or older (10 times greater risk than younger people) 4
V. Complications of CDI or CDAD A. Dehydration with electrolyte imbalance 5 B. Perforation of (hole through) the colon 5 C. Toxic megacolon- a disorder where the infection causes rapid dilation of the colon. If rapid widening is allowed to continue, an opening (perforation) can form in the colon. Therefore, most cases of toxic megacolon will require surgery, such as colectomy (removal of the entire colon). In this case you might also be placed on antibiotics to prevent sepsis. 5 D. Colitis or Pseudomembranous colitis 3 E. If pseudomembranous colitis or toxic megacolon are left untreated- Death. 3
VI. Tests and Diagnostics related to Clostridium difficile detection A. Bacterial stool culture 1. Fresh random stool collected in a clean plastic container taken to the lab within 15-30 minutes. 6 2. “C. difficile toxins can be more rapidly identified from a stool sample using an immunochemical method than from a routine culture. These tests are not run on a specimen unless requested by the physician.” 6 B. Colon examination 1. In some cases, to help confirm a diagnosis of C. difficile infection, your doctor may examine the inside of your colon. This test (flexible sigmoidoscopy) involves inserting a flexible tube with a small camera on one end into your lower colon to look for areas of inflammation and pseudomembranes. 6 C. Imaging tests. 1. If there 's concern about possible complications of C. difficile, your doctor may order a computerized tomography (CT) scan, which provides detailed images of your colon. The scan can show a thickening of the wall of your colon, which is common in pseudomembranous colitis. 6
VII. Treatments and Drugs for CDAD A. Antibiotics 1. Metronidazole (Flagyl)- Usually the first choice of physicians. 7
. 2. Vancomycin (Vancocin)- Typically used only for severe cases. Usually prescribed on a tapered schedule for up to 7 weeks. Extremely expensive! 7 3. Fidaxomicin (Dificid)- Just approved by the FDA on 05/27/11. “Clinical response was similar to vancomycin… in some patients with CDAD, symptoms can return. In the Dificid trials, a greater number of patients treated with Dificid had a sustained cure 3 weeks after treatment ended versus those patients treated with vancomycin.” 8 B. Probiotics 1. A yeast called Saccharomyces boulardii, in conjunction with antibiotics, might help prevent recurrent C. difficile infections. 3 C. Surgery 1. For people with severe pain or organ failure related to the CDI, surgical removal of the infected portion of the colon (colectomy) may be the only option. 3 D. “Stool Transplants” 1. First, the undigested matter from the donor stool must be removed with some sort of straining device. Next the remaining fluid is spun in a centrifuge to reduce the material into a bacterial “pellet.” Finally the pellet may be introduced to the patient through a nasogastric tube, or reconstituted in liquid and inserted into the rectum in the form of an enema. 2
VIII. Prevention A. Handwashing is the single most important method of infection prevention. Soap and water have proven to be more effective at removing the bacterial spores associated with C. difficile. 3 B. Contact precautions- people who are hospitalized with C. difficile should have a private room or share a room with someone who has the same illness. Hospital staff and visitors wear disposable gloves and gowns while in the room. 3 C. Thorough cleaning of all surfaces should be carefully disinfected with a product that contains chlorine bleach. C. difficile spores can survive routine cleaning products that don 't contain bleach. 3 D. “Avoid unnecessary use of antibiotics. Antibiotics are sometimes prescribed for viral illnesses that aren 't helped by these drugs. If you do need an antibiotic, ask your doctor to prescribe one that has a narrow range and that you take for the shortest time possible.” 3
References
1.
“Frequently Asked Questions about Clostridium difficile for Healthcare Providers.” Healthcare-associated Infections. Centers for Disease Control and Prevention. 25 Nov. 2010. Web. 19 June 2011. <http://www.cdc.gov/HAI/organisms/cdiff/Cdiff_faqs_HCP.html>.
2. Lewis, Sharon L., et al. Medical-Surgical Nursing: Assessment and Management of Clinical Problems. 8th ed. St. Louis: Elsevier, 2011. Print.
3. The Mayo Clinic Staff. “C. difficile.” MayoClinic.com. Mayo Clinic for Medical Education and Research (MFMER). 03 Nov. 2010. Web. 14 June, 2011. <http://www.mayoclinic.com/health/c-difficile/DS00736>.
4. “Clostridium difficile infection.” FamilyDoctor.org. American Academy of Family Physicians. Feb. 2011. Web. 21 June 2011. <http://familydoctor.org/online/famdocen/home/common/infections/common/bacterial/939.printerview.html>.
5. Vorrick, Linda J., MD. “Pseudomembranous Colitis.” Medline Plus. U.S. National Library of Medicine. Apr. 2010. Web. 22 June 2011. <http://www.nlm.nih.gov/medlineplus/ency/article/000259.htm>.
6. Van Leeuwen, Anne M., and Debra J. Poelhuis-Leth. Davis’s Comprehensive Handbook of Laboratory and Diagnostic Tests with Nursing Implications. 3rd ed. Philadelphia: F.A. Davis Company, 2009.
Print.
7. Deglin, Judith, April Vallerand, and Cynthia Sanoski. Davis’s Drug Guide for Nurses. 12th ed. Philadelphia: F.A. Davis Company, 2011. Print.
8. Liscinsky, Morgan. “FDA approves treatment for Clostridium difficile infection.” FDA News Release. The U.S. Food and Drug Administration. 27 May 2011. Web. 21 June, 2011. <http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm257024.htm>.