C difficile
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This document summarizes key information about Clostridium difficile infection (CDI), including: 1) C. difficile attaches to gut epithelial cells and produces toxins that can cause pseudomembranous colitis, toxic megacolon, and death when normal gut flora is disrupted by antibiotics. 2) Major risk factors for CDI are antibiotic exposure, hospitalization, and advanced age. Certain antibiotics like cephalosporins, clindamycin, and fluoroquinolones are more likely to facilitate CDI. 3) Diagnosis of CDI involves testing stool samples for toxins A and B, typically using enzyme immunoassay, toxigenic culture
C difficile
- 1. A New Guide C Difficile Medical Surgical Nursing II
- 2. CDI’s Development • C difficile attaches to receptors in the gut epithelial cell • Pivotal is exposure to antibiotics, which destroys the normal gut microbiota and allows intestinal organisms that are not killed by the antibiotic to proliferate
- 3. CDI’s Development • C difficile attaches produces toxins, resulting in pseudomembranous colitis and, in some cases, toxic megacolon and death • Normal intestinal flora are able to suppress C difficile and toxin production, preventing the diarrhea and inflammation characteristic
- 4. CDI Risk Factors • Main risk factors for CDI: – Exposure to antibiotics – Hospitalization – Advanced age
- 5. CDI vs. Antibiotics • Antibiotics: – Most antibiotic classes have been implicated in CDI, but certain antibiotic classes, such as cephalosporins, clindamycin, and fluoroquinolones, are more likely to facilitate development of disease • antibiotics to disrupt normal lower intestinal microbiota – Fluoroquinolones are hypervirulent strains known as restriction endonuclease analysis type BI • Virulence is r/t increased production of toxin A; B & Binary • Synergistic with toxins A and B.
- 6. CDI Diagnosing • CDI is a toxin-mediated disease, which is the basis testing – enzyme immunoassay (EIA) for toxins A and B – toxigenic stool culture – cell cytotoxicity – glutamate dehydrogenase testing – polymerase chain reaction (PCR),
- 7. TESTING INS & OUTS • EIA – relatively inexpensive, • easy to perform, – rapid turnaround time – poor sensitivity, can result in repeat testing and overtreatment. • Toxigenic stool culture, cell cytotoxicity, and glutamate dehydrogenase testing – Expensive – slower, – complicated to perform • PCR – used either alone or in combination with EIA • Understand the limitations of the test & how results might change with a different test. • Testing only symptomatic patients – Pt. who are tested must be having diarrhea
- 8. CDI’s Surveillance &Tracking • Surveillance – guide defines surveillance as regarding a health- related event to reduce morbidity and mortality and to improve health – use of a case definition for CDI, – identification of the patient population at risk, – calculation of CDI rates, – use of control charts • Tracking – CMS Inpatient PPS required – Reporting of laboratory- identified CDIs through National Health Safety Network (NHSN)
- 9. Transmission of C difficile • Ingesting spores found in the environment that were shed by another patient • Beds • Toilets – flush mechanism – the sink faucet – the door handle • Everyday items
- 10. CDI Cross-Contamination • Sharing of electronic thermometers • Oral care or oral suctioning when hands or items are contaminated; • Administration of tube feedings or medication; • Emergency procedures, such as intubation; • Sharing of patient care items without appropriate disinfection; • Use of contaminated mobile, cellular, or conventional telephones or pagers during patient care
- 11. CDI Prevention • Contact isolation • Environmental cleaning • Hand hygiene • ABHR - alcohol-based hand rubs • Best way – Gloving – removed properly to avoid contaminating • During outbreaks hand washing rather than hand rubs
- 12. Thanks…..