ALPHA
Gram-positive, rod-shaped anaerobe
Opportunistic when antibiotics remove other bacterial competition and can get out of control. Toxins produed - toxin A (enterotoxin) and toxin B (cytotoxin)
The antibiotics most associated with C. diff start with the letter C:
- Clindamycin
- Ciprofloxacin (and other fluoroquinolones)
- Cephalosporins
- Carbapenems (e.g., meropenem)
PPIs are also a risk factor for C. difficile infection
Diagnosis
Diagnosis is based on stool samples. Stools can be tested for:
- C. diff antigien - only shows presence of C. diff not active infection. Screening test
- A and B toxins (PCR) - shows active infection
Management
- Oral vancomycin 1st
- Oral fidaxomicin 2nd
Source isolated for 48 hrs after the last episode of diarrhoea. High recurrence rate. Foaecal microbiota transplant is an option for recurrent cases after 2 or more episodes
Complications
Pseudomembranous colitis
Inflammation in the large intestine with yellow/white plaques that form pseudomembranes on the innser surface of the bowel wall. Seen during a colonoscopy and confirmed with biopsies
Toxic megacolon
Complication of severe inflammation in the large intestine and involves dilation of the colon. Patients are very unwell and have a high risk