Clostridium difficile

Presented by: Ebony PorterSchool of Medical TechnologyCarolinas College of Health Sciences

ObjectivesUpon completion of this presentation

and viewing the display board, the audience will be able to:

Understand the bacteriology behind C. difficile and analyze why it is a cause for concern in the hospital and nursing home environments

Contrast C. difficile’s toxin A and toxin B and the role they play in the development of diseases

Evaluate the tests and methods used to recover or detect C. difficile

Objectives

Differentiate the recommended treatments and assess their effectiveness

Summarize the preventative measures used to reduce the spread of the organism in the community and hospital setting

Recall the notable outbreaks of C. difficile

Bacteriology

gram-positive rod anaerobic spore-forming large (2-17 μm) produces heat-labile

toxins (A & B) grows on highly

selective cefoxitin, cycloserine, egg yolk, and fructose agar

C. difficile toxins

Toxin A enterotoxin 308 kDa produces acute inflammation, induces fluid

secretion, and causes necrosis of the epithelium

Toxin B cytotoxin 270 kDa more potent than toxin A

More about Clostridium difficile

ubiquitous (soil, air, humans, animals) termed the “difficult clostridium” by

Hall and O’Toole in 1935 causes one of the most widespread

and potentially serious illnesses in the hospital and nursing home communities

Cause and Transmission

Use of broad-spectrum antibiotics, antiviral, antifungal, and chemotherapy drugs eliminates the “helpful” bacteria

Transmitted via the fecal-oral route in the vegetative state or spores

Rapidly multiplies and produces toxins

Symptoms

Watery diarrhea Abdominal pain Fever Nausea Blood and pus in stool Foul stool odor Dehydration Weight loss

Diseases and Complications Clostridium difficile-associated

diarrhea (CDAD) Pseudomembranous colitis (PMC) Dehydration Kidney failure Bowel perforation Toxic megacolon Death

Diagnosis

Enzyme immunoassay kits (EIA) Endoscopy or colonoscopy Computerized tomography scan

Colonoscopy

NORMAL COLON

PMC

Risk Factors

Antibiotic therapy Elderly Immunocompromised Abdominal surgery Chronic colon disease Extended hospital or nursing home

stay

Prognosis

Excellent for people with a mild case of CDAD

More severe cases of CDAD may need two rounds of treatment

If CDAD goes untreated may lead to complications

Treatments

Anti-clostridial antibiotics – metronidazole or vancomycin

Probiotics – Saccharomyces boulardii

Colectomy – surgery to remove infected part of the colon

Prevention

Hospital staff should wear disposable gloves, gowns, wash hands

Isolate infected patients

Disinfect surfaces and instruments with chlorine bleach

Only use antibiotics when necessary

Outbreaks

Quebec strain NAP1/027 – virulent strain responsible for deaths in Quebec, Alberta, Ontario, United Kingdom, England, Ireland, and Finland

New strain BI/NAP1 – contains a different toxin called binary toxin that is quickly emerging in North America

Outbreaks

References

"Clostridium difficile". Wikipedia. <http://en.wikipedia.org/wiki/Clostridium_difficile>.

Cunha, Burke A.. Infectious Diseases in Critical Care Medicine, 2nd edition. New York: Informa Healthcare USA, Inc., 2007. (AHEC)

"General Information about Clostridium difficile Infections". CDC. <http://www.cdc.gov>.

Gronczewski, Craig. "Clostridium Difficile Colitis". Web MD. <http://www.emedicine.com>.

Mayo Clinic Staff, "C. Difficile". Mayo Clinic. <http://www.mayoclinic.com/health>.

Scheld, W.M., Craig W.A., and Hughes J.M.. Emerging Infections. Washington, D.C.: ASM Press, 2001. (AHEC)

Schroeder, Michael S. "Clostridium Difficile-Associated Diarrhea." American Family Physician 71 (2005).