Clostridium difficile

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Clostridium difficile

• Presented by
• Nate Smith, MD, MPH
• Carole Yeung, RN CIC

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Outline

• Epidemiology
• Treatment
• Prevention

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What is Clostridium difficile?

• Anaerobic spore-forming bacillus
• Present in the soil and environment
• Produces two toxins Toxins A and B
• Common cause of antibiotic associated diarrhea
  (AAD). 15 25 all episodes of AAD
• Health care settings are major reservoirs
• 20 40 hospital patients colonized
• 4 20 LTCF residents colonized

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What are C. difficile-associated diseases (CDAD)

• Pseudomembranous colitis (PMC)
• Toxic megacolon
• Perforations of the colon
• Sepsis
• Death (rarely) but increasing!

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CDAD-related deaths - Arkansas
2005 data incomplete
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Symptoms of CDAD

• Watery diarrhea
• Fever
• Loss of appetite
• Abdominal pain
• Nausea and vomiting
• Severe cases increase WBC and/or creatinine
• Can occur up to 8 weeks after antimicrobial
  therapy

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Which patients are at increased risk for CDAD?

• Antibiotic exposure clindamycin, penicillins,
  cephalosporins, floroquinolones
• Gastrointestinal surgery
• Length of stay in healthcare settings
• A serious underlying illness
• Immunocompromising conditions
• Advanced age

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C. difficile colonization

• Patient exhibits no clinical symptoms
• Patient tests positive for C. difficile organism
  and/or its toxin
• More common than CDAD

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C. difficile disease (CDAD)

• Patient exhibits clinical symptoms
• Patient tests positive for C. difficile organism
  and/or its toxin

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Laboratory Tests for CDAD

• Stool culture
• Antigen detection
• Toxin testing

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C. difficile Transmission

• C. difficile spores are shed in feces
• Any surface, device or material that becomes
  contaminated with feces may serve as a reservoir
• Transferred by hands of healthcare personnel

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Treatment

• Discontinue antibiotics if feasible
• Metronidazole orally for 10 days
• Vancomycin orally
• Relapses are common
• Repeat testing NOT recommended
• NO antiperistalic agents

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Infection Control Preventive Methods

• Use antibiotics judiciously
• Early diagnosis
• Contact precautions for patients with CDAD
• Hand hygiene
• Environmental cleaning and disinfection

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Contact Precautions

• Private room or cohort
• Gloves
• Gowns
• Dedicated patient care equipment

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Hand Hygiene

• Soap and water for at least 15 seconds
• Wet hands under running water
• Apply soap
• Good friction rub for 15 seconds
• Rinse hands
• Dry well with paper towel

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Cleaning and Disinfection

• Clean/disinfect environmental surfaces and
  reusable items
• Hospital disinfectant
• 110 bleach

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Discontinuing Precautions

• NO diarrhea. NO precautions!
• Repeat testing NOT recommended

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Transfer of Patients

• Notify receiving facility if patient has a
  history of C. difficile
• Observe for recurrence

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References

• SHEA Position Paper CDAD, ICHE 1995
• SHEA Position Paper C. difficile in LTCF for the
  elderly, ICHE 2002

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QUESTIONS?