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Clostridium difficile

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Clostridium difficile

  • Characteristics
    • Common to all bacteria in Clostridia family
    • Gram + rods
    • Obligate anaerobe
    • Spore-forming
  • Exposure/Risk Factors
    • Antibiotics (esp. broad-spectrum)
      • C. diff is small part of normal gut flora; killing other gut flora by antibiotics creates opportunities for C. diff. to overgrow
      • Commonly associated with clindamycin and ampicillin use
  • Produces 2 toxins
    • Enterotoxin A
      • Disrupts tight junctions of gut to alter fluid secretion in gut
        • Leads to intestinal inflammation (enterotoxic)
        • Causes watery diarrhea
    • Cytotoxin B
      • Disrupts cytoskeleton via actin depolymerization to kill cells
        • Leads to cell death (cytotoxic)
        • Causes colonic epithelial necrosis, inflammation, and fibrin deposition (colitis)
  • Presentation
    • Watery diarrhea
    • Pseudomembranous colitis
      • White/yellow plaques on colonoscopy
      • marked thickening of the colonic wall (accordion sign), irregularity of bowel wall, pericolonic stranding on CT
    • Abdominal pain, weight loss, malaise, dehydration may also be seen
  • Treatment
    • Contact precautions must be used
      • Non-sterile gloves and gown
    • Vancomycin or Metronidazole
      • First-line treatment for isolated C. diff infection
    • Fidaxomicin
      • Used primarily for recurrent infections