CICM SAQ 2014.1 Q14

Questions

With regards to Clostridium difficile (C. difficile) infection in critically ill patients:

a) What are the risk factors for development of this condition?
b) What complications can occur as a result of this infection?
c) How is the diagnosis of C. difficile and its complications established?
d) Briefly outline the options for prevention and treatment.


Answers

Answer and interpretation

a) What are the risk factors for development of this condition?

Risk factors:

  • Exposure to antibiotics
  • Clindamycin
  • Cephalosproins
  • Fluoroquinolones
  • Extended spectrum penicillins
  • Extremes of age
  • Immunosuppression
  • Proton pump inhibitors and H2 antagonists
  • Nursing home or group care home

b) What complications can occur as a result of this infection?

Related to the diarrhoea

  • Hypovolaemia
  • Electrolyte disturbance; hypokalaemia, hypomagnesaemia

Related to the intestinal infection

  • Sepsis and septic shock o Perforation
  • Toxic megacolon
  • Bleeding

c) How is the diagnosis of C. difficile and its complications established?

Clinical findings

  • Diarrhoea, but may have severe disease without diarrhoea o Abdominal pain, colic in nature
  • Fever
  • Shock

Microbiology

  • Stool; C. difficile toxin (false negatives problematic)
  • PCR for C. difficile (false positives problematic)
  • ELISA for C difficile glutamate dehydrogenase

Sigmoidoscopy, colonoscopy

  • Pseudomembranes

CT scan

  • Abdominal and pelvis
  • Oral and ivi contrast
  • Helps to diagnose complications such as toxic megacolon, perforation and exclude differential diagnosis

d) Briefly outline the options for prevention and treatment.

Prevention

  • Antibiotics stewardship, limitation of broad spectrum antibiotics
  • Isolation of C diff positive cases with notices advising contact precautions
  • Limit spread with hand washing with soap and water, alcohol hand rub is ineffective

Treatment

  • Supportive care and resuscitation
  • Specific
  • Medical – Antibiotics;
    • Oral vancomycin (250 – 500 mg enteral q6h)
    • Metronidazole oral or ivi
    • Tigecycline
  • Surgical
    • For perforation or toxic megacolon
    • Subtotal colectomy
  • Monoclonal antibodies and vaccine under development
  • Faecal transplant
    • More for recurrent infection than for acute severe illness

Exams LITFL ACEM 700

Examination Library

CICM

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.