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Infection Control & Related Microbiology DAHS 1010, DAHS 2010

Infection Control & Related Microbiology DAHS 1010, DAHS 2010. Clostridium difficile Beverley Gallacher. Description & Classification. Gram +ve Anaerobic Bacillus Spore forming Commensal in gut, first identified 1935 in meconium “difficile” dificult to culture, grows slowly.

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Infection Control & Related Microbiology DAHS 1010, DAHS 2010

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  1. Infection Control & Related Microbiology DAHS 1010, DAHS 2010 Clostridium difficile Beverley Gallacher

  2. Description & Classification • Gram +ve • Anaerobic • Bacillus • Spore forming • Commensal in gut, first identified 1935 in meconium • “difficile” dificult to culture, grows slowly

  3. Historical background • Animal models showed antibiotic (clindamycin) treatment associated with colitis. • Stool filterate could reproduce colitis  TOXIN • C difficile and toxin found in stools of patients with pseudomembranous colitis

  4. Mechanism of Infection Penicillins, Cephalosporins Broad spectrum antibiotics disturb normal flora allows colonisation infection Endogenous Exogenous

  5. Other Predisposing Factors Susceptible host - immunosuppressed, immunocompromised, ICU patients, elderly - those over 65 Gut flora disturbances Aperients, enemas, antacids, bowel surgery

  6. Environmental contamination (exogenous infection) • Isolated from floors, toilets, bedpans, furniture • Also HCW’s hands - important mode of transmission - direct or indirect contact with faeces/spores Pathophysiology • Toxins (A & B) - mucosal damage, inflammation & fluid secretion

  7. Clinical Presentation • Spectrum of disease mild diarrhoea  colitis  pseudomembranous colitis & toxic megacolon • Sudden onset unexplained diarrhoea • Foul smelling stool with mucus, usually no blood • +/- fever • History of antibiotic use • Abdominal pain, nausea, dehydration • Culture of C diff & toxin detection

  8. Management - patient treatment • Stop the inducing antibiotics & rehydrate the patient • Treat with metronidazole (400mg 8hrly) for 7 - 10 days  vancomycin (125 mg 6hrly) oral  IV • ?? Biocultures - lactobacillus spp. “Yacult” • Treatment successsful when symptom free for 48 hours. Clearance specimen not required

  9. Management - control spread of infection • Source Isolation • “enteric precautions” • universal precautions - thorough handwashing, protective clothing, disposal of body fluids, waste & linen, • twice daily cleaning of environment • Think about what goes in the isolation room and what stays outside

  10. Relapse • Approx 20% patients have a symptomatic relapse after completing treatment Germination of residual spores Reinfection environmental spores Further antibiotic treatment Reinstate IC precautions, obtain repeat specimens

  11. References • Mllett J & Bailey C (1998) “Royal Marsden” Manual of Clinical Nursing Procedures 4th Ed • (2000) Leeds Teaching Hospitals Trust Infection Control Policies • Wilson J (2001) Infection Control in Clinical Practice. Bailliere Tindall • Tabaqchali S jumaa P (1995) Diagnosis & management of Clostridium difficile infection BMJ 310 p1375

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