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Second Chance Exam - C. diff

What are characteristics of Clostridium difficile? (MULTI ANSWER)
Gram positive rods
Anaerobic
Spore-forming
Toxin-producing
Gram negative clusters
Aerobic
What is the significance of NAP1/BI/027 strain? (MULTI ANSWER)
Increased virulence
Production of binary toxin
Highly resistance to FQs
Easily treated
Highly susceptible to FQs
Localized
What is evidence of severe-complicated C.diff? (MULTI ANSWER)
WBC > 15,000
SCr > 1.5x baseline
Hypotension
WBC < 15,000
SCr > 2.5x baseline
Euvolemia
Risk factors for C.diff include: (MULTI ANSWER)
Recent abx exposure
>65 YO
Duration of hospital stay
Recent GI surgery
PPI use
IBD/Immunosuppression
Tobacco use
AKI
Liver disease
These antibiotics are frequently associated with C.diff: (MULTI ANSWER)
FQs
Clindamycin
Broad spec PCN
Broad spec cephalosporin
Macrolides
Sulfonamides
Vanco
Metronidazole
AGs
Tetracyclines
These antibiotics are rarely associated with C.diff.: MULTI ANSWER
FQs
Clindamycin
Broad spec PCN
Broad spec cephalosporin
Macrolides
Sulfonamides
Vanco
Metronidazole
AGs
Tetracyclines
What is the "gold standard" for diagnosing C.diff?
Cytoxicity assay
Stool culture
PCR
Enzyme Immunoassay
Abdominal CT is specific and sensitive for C.diff.
True
False
Lower GI endoscopy can visualize pseudomembranes 50% of the time
True
False
What regimen should be used for severe-compliated C.diff?
Vancomycin 500 mg PO q 6 hours plus metronidazole 500 mg IV q 8 hours
Vancomycin 500 mg IV q 6 hours plus metronidazole 500 mg IV q 8 hours
Vancomycin 125 mg PO q 6 hours plus metronidazole 500 mg IV q 8 hours
Metronidazole 500 mg PO q 8 hours
What regimen should be used for Mild/Moderate CDI?
Vancomycin 500 mg PO q 6 hours plus metronidazole 500 mg IV q 8 hours
Vancomycin 500 mg IV q 6 hours plus metronidazole 500 mg IV q 8 hours
Vancomycin 125 mg PO q 6 hours plus metronidazole 500 mg IV q 8 hours
Metronidazole 500 mg PO q 8 hours
Metronidazole 500 mg PO TID x 10-14 days
What regimen should be used for severe-UNcompliated C.diff?
Vancomycin 500 mg PO q 6 hours plus metronidazole 500 mg IV q 8 hours
Vancomycin 500 mg IV q 6 hours plus metronidazole 500 mg IV q 8 hours
Vancomycin 125 mg PO q 6 hours plus metronidazole 500 mg IV q 8 hours
Metronidazole 500 mg PO q 8 hours
Vancomycin PO/NG 125 mg 4 times daily x 10-14 days
What treatment should be added if the patient is found to have an ileus?
Vancomycin 500 mg PO q 6 hours
Vancomycin 500 mg IV q 6 hours
Vancomycin 125 mg PO q 6 hours
Metronidazole 500 mg PO q 8 hours
Vancomycin 500 mg PR q 6 hours
What medications should be avoided in CDI and why? (MULTI ANSWER)
Antiperistaltic - Toxic Megacolon
Antimicrobials
PPIs - decrease medication absorption
Should patients be recommended to take probiotics to prevent recurrent C.diff?
Yes
No
For a SECOND recurrence, what therapy should be recommended?
Vanco taper
Vancomycin 500 mg PO q 6 hours
Metro taper
Metronidazole 500 mg IV q 8 hours
Why should metronidazole be avoided beyond second recurrence?
Peripheral neuropathy
Resistance
Risk of toxic megacolon
What is an alternative treatment for mild-moderate C.diff infection?
Vancomycin 125 mg PO q 6 hours plus metronidazole 500 mg IV q 8 hours
Metronidazole 500 mg PO q 8 hours
Metronidazole 500 mg PO TID x 10-14 days
Fidaxomicin 200mg PO BID x 10d
Is this a suitable vancomyin taper? 125 mg PO 4 x day x 10-14 days 125 mg PO 2 x day x 1 week 125 mg PO once daily x 1 week 125 mg PO every 2-3 days x 2-8 weeks
Yes
No
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