C. Diff.-What's the Latest?

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C. Diff.-What's the Latest?

C. Diff.‐What’s the Latest?Jack D. Bragg, D.O. F.A.C.O.I.Associate Professor of MedicineiUniversity of Missouri‐ColumbiaDirector‐Inflammatory BowelDisease Team

Isolates of Clostridium difficile According to Health Care Facilityand the Proportion of Isolates Belonging to the BI/NAP1 StrainMcDonald L et al. N Engl J Med 2005;353:2433‐2441

CDI‐ Epidemiology, TransmissionCarriage/colonizationg/• Healthy adults‐ 2%, children < 1 yo‐ much higher• Hospitalized adults‐ 7‐25%, LTCF‐ 5‐10%• Hospitalized 4 weeks‐ 50%• Nosocomial via HCW hands, equipment, hardware• Incubation period‐ 2‐3 daysRisks for Disease• Antibiotics, duration of hospitalization, ti chemotherapy,age, GI surgery, feeding tubes, therapy with PPIs

Diagnostic Tools andInfection Control

CDI Treatment‐ Principles• Stop other antibiotics ASAP, if possible• Avoid antiperistaltic agents‐ risk of megacolon• Institute infection control measures• Stool testing• Empiric i therapy• Choice of initial therapy based on diseaseseverity• What if the tests are negative?

Suggested Approaches to TherapyKelly C and LaMont J. N Engl J Med 2008;359:1932‐1940

References• Clostridium difficile Infection in Primary Care: Tackling a Virulent PathogenFriedenberg FK, Johnson S, Mundy LM. CME Medscape.com Published02/27/2009.• Update on the changing epidemiology of Clostridium difficile‐associated ile iated diseaseMcFaraland LV. Nature Clinical Practice Gastroenterology & Hepatology, January2008, p. 40‐48.• Clostridium difficile and Inflammatory Bowel DiseaseIssa M, Ananthakrishnan AN, Binion DG. Inflammatory Bowel Disease, Vol. 14,Number 10, October 2008, p. 1432‐1442. 1442.• Clostridium difficile‐More Difficult Than Ever ‐ Review ArticleKelly CP, LaMont JT. NEJM, 2008;359:1932‐40.

References• A 76‐Year‐Old Man With Recurrent Clostridium difficile Associated Diarrhea:Review of C difficile InfectionCiaran P. Kelly. JAMA, 2009;301 (9):954‐962.• Clostridium difficile‐More Difficult Than EverCiaran P. Kelly, MD and J. Thomas Lamont, MD. NEMJ, 2008; 357:1932‐40.• Clostridium difficile infection: an emerging gepidemic with more questions thananswersHerbert L DuPont and Kevin W Garey. Future Microbiol. (2010) 5 (8), 1153‐1156.• The management of Clostridium difficile infectionO. Martin Williams and Robert C. Spencer. British Medical Bulletin, 2009; 91:87‐110. Idsociety.org IDSA practice guidelines.

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