C-Diff Research Paper

Clostridium difficile associated disease will resolve when the patient discontinues taking the antibiotics to which he/she has been previously exposed (Nipa, 2010). Administration of a different antibiotic is used to treat the infection (Grossman, 2010). The infection can usually be treated with an appropriate course of about 10 days of antibiotics including metronidazole or vancomycin administered orally (Nipa, 2010). On occasion intravenous vancomycin may be necessary (Gould, 2010). The nurse should ensure patients are not only taking the newly prescribed antibiotic, but also responding to the treatment by showing a decrease in symptoms. Symptoms can recur despite antibiotic therapy, close monitoring is essential. In order to avoid risk of further complications, nursing interventions would include careful assessment of white blood cell count, temperature, and hydration status; meticulous skin care and assistance with bowel elimination given the loose frequent stools; and management of abdominal discomfort (Grossman, 2010).

Clostridium difficile is a Gram-positive, spore-forming, rod-shaped bacillus that is renowned for being the leading cause of hospital-acquired diarrhea in adult patients. C. difficile is present as normal intestinal flora within 3% to 5% of healthy people2, while its spores are ubiquitous in the environment, especially in hospital settings. It grows at an optimal temperature and pH of 37ºC and 6.5–7.5 respectively.1 It is an obligate anaerobic as it thrives in the absence of oxygen. It is highly motile with the presence of peritrichous flagella, which are evenly spread out along its surface. As briefly mentioned above, this evolving pathogen produces endospores. The bacterium produces dormant spores, which are extremely hardy and resistant to antibiotics, the host’s innate immune system, and once shed into the environment through the host’s feces, they are resistant to unfavorable aerobic conditions3 as well as several types of bleach-free disinfectants, which are commonly used in hospitals.3 The spores will germinate under the favorable conditions of the intestinal tract, resulting in the multiplication of vegetative cells, colonizing in the gastrointestinal tract. The vegetative cells release two powerful exotoxins upon adherence to the epithelial cells of the GI tract. Pathogenic strains of C. difficile produce two exotoxins: toxin A and toxin B. Toxin A is an enterotoxin that causes fluid excretion, resulting in fluid accumulation and watery diarrhea. Toxin B is a potent

Clostridium difficile, also known as C. diff, is a bacterium that causes severe symptoms, including inflammation of the colon, which can be life threatening (Centers for Disease Control and Prevention, 2015). It is a very common infection that affects hundreds of thousands in the United States alone. If not caught and treated early, it can be deadly. I kills thousands of people in the United States every year (Mayo Clinic Staff, 2017). It is extremely important to learn the signs and symptoms of this infection so treatment can begin as early as possible.

Clostridium difficile is a spore forming, anaerobic, toxin-producing, gram-positive bacillus that is the most common cause of nosocomial, antibiotic-associated diarrhea (15-25%).1,2,3 The pathogenesis of C. difficile-associated diarrhea (CDAD) is the result of broad spectrum antibiotics, such as clindamycin, flouroquinolones or ceftriaxone, which reduces the population of normal bowel flora and allowing for an overgrowth of C. difficile.1,2 The toxins synthesized by C. difficile, A and B, lead to the inflammation and damage of the intestinal mucosa creating the symptoms of C. difficile infection (CDI). These symptoms can range from asymptomatic carriers, to mild diarrhea to sudden and occasionally deadly colitis. The clinical practice guidelines for the treatment of CDAD recommends the use of metronidazole (MET) and vancomycin (VAN) that is dependent upon the severity of the CDI.1,2,3

Clostridium difficile is a bacterium that infects humans, animals, water, soil, feces and food products. Clostridium difficile also known as C. diff or C. difficile is an asymptomatic infection due to the spore-forming bacterium which causes inflammation of the colon. C. diff is very contagious; it is a microorganism that can be spread from person to person by touch or direct contact. Symptoms with severe infections cause watery diarrhea ten to fifteen times a day, rapid heart rate, blood or pus in stool, dehydration, kidney failure, increased white cell count and, abdominal cramping. Symptoms with mild to moderate infections cause watery diarrhea three to more times a day and abdominal cramping. Approximal half a million people get infected with C. diff each year in the United States.

Clostridium difficile is a Gram-positive anaerobe bacteria meaning it does not have the ability to grow in the presence of oxygen. There are two different exotoxins produced by the organism Clostridium difficile, toxin A and toxin B. The organism produces spores which are the contagious particles of the bacterium. These spores are found all over our environment and in feces of both animals and humans. It is very hard to annihilate these spores due to them being resistant to alcohol, disinfectants, heat and radiation (Awad, 2014). Infection by C. difficile occurs through the fecal-oral route during ingestion of spores. As these spores pass through the gastrointestinal system, bile acids and other substances stimulate their germination. Toxins may be produced depending on the microflora that exists in the gastrointestinal tract. Colonization and proliferation, which are likely to involve numerous surface structures and adhesions, primarily occur in the suitably anaerobic

C. diff is a gram-positive, rod shaped bacterium. It is also spore forming and anaerobic, which means that it is able to live in dirt for up to two years. Human and animal feces are where this bacterium is most commonly found. These are not the only places though; C. diff can also be found in soil, air, water, and processed meat. C, diff can be found in many healthy people intestines or colon. You can carry the bacteria with no symptoms because the millions of good bacteria in you are able to keep it under control. C. diff because present and starts to cause problems when you take antibiotics. The antibiotics kill off the good bacteria in you allowing the resilient C. diff to overpopulate. The spores’ produce when antibiotics attack the bacteria (APIC). The antibiotics that most commonly cause C. diff are fluoroquinolones, cephalosporins, penicillins and clindamycin (Mayo Clinic, 2016). Being on antibiotics is not the only way to get infected. C. diff is highly contagious. If people are not washing their hands thoroughly it can easily be spread along any surface and even into

Clostridium difficile is a gram positive, anaerobic, spore forming bacillus. In 1935 it was first described as member of the intestinal flora in healthy neonates [1] , and then in 1978 it was recognised as a cause of diarrhoea [2]. Today it is widely acknowledged as the leading cause of hospital-acquired diarrhoea. This organism can cause a variety of diseases, from mild diarrhoea to severe pseudomembranous colitis, and collectively these are known as C. difficile infections (CDIs) [3]. It is known that the symptoms seen in patients infected with C. difficile are due to the toxins (toxin A and toxin B) that are produced by the organism [4]. Some strains of C. difficile seem to have an increased virulence which can be associated with increased severity, recurrence and increased mortality. This increased virulence is thought to be a result of increased expression of toxins A, B [5]. There is also another toxin produced by C. difficile known as binary toxin, this is also thought to contribute towards increased virulence [6]. A particular strain of C. difficile that does seem to have increased virulence is the strain known as PCR ribotype O27 or North American pulsed (NAP)-field type 01. In Europe PCR ribotype O27 is the sixth most common ribotype [7], and new ribotypes are being detected that appear to have evolved from the O27 lineage [8], making the need for a method to demonstrate strain relatedness highly important. In a hospital setting knowing the

Furthermore, in the past 10-15 years, Clostridium difficile infection (CDI) has emerged as an increasingly important infectious disease worldwide. C. difficile is an antibiotic-associated bacteria that causes asymptomatic

Clostridium difficile is a bacterium that is found in the human colonic flora that can cause diarrhea and more serious conditions, such as colitis. This occurs if the physiological bacterial flora is changed or damaged due to prolonged antibiotic use and if the concentration of C. difficile increases significantly. The prolonged antibiotic use enables C. difficile to multiply and produce large amounts of dangerous toxins. Therapy for those who suffer from this includes rehydration, immediate stop of the causative antibiotic (usually clindamycin or amoxicillin), and new antibiotics to reverse the symptoms such as vancomycin. C. difficile is easily transmitted within hospital settings because its spores are resistant to the commonly used alcohol

difficile infection, but all of these methods have limitations and some of them are now considered suboptimal(2). The ideal laboratory test for CDI would be sensitive, specific, rapid, simple to perform, and inexpensive. Culture Just after the discovery of the pathogenic role of C. difficile proposed a selective agar plate called CCFA (cycloserine cefoxitin fructose agar) for the isolation from stool specimens. The selective agents are cycloserine at a concentration of 500 mg/L and cefoxitin at 16 mg/L. Culture is the most sensitive method but it is not very specific due to the possibility of isolating non-toxigenic isolates (14). Fecal diagnostic tests anaerobic toxigenic culture of C. difficile and the cell culture cytotoxicity assay, with neutralization with clostridial antitoxin, are the most sensitive for diagnosis of CDI but time-consuming (5). For many years, cell culture cytotoxicity neutralization assay (CCCNA) was the accepted gold standard. By this method, stool filtrates are inoculated onto a monolayer of a cell culture in wells with and without C. difficile antitoxin. CCCNA is quite specific for CDI. However, the assay is expensive, lacks standardization among laboratories and is generally unavailable outside the research setting (11). The enzyme immunoassay (EIA) became broadly used because of its rapidity in performance, but EIA used for toxin detection lack sensitivity and are considered suboptimal for diagnosing C. Difficile infection (11). A laboratory assay measuring the clostridial protein, glutamate dehydrogenase (GDH), represents a rapid,

Clostridium difficile infection (CDI) is the most common cause of antibiotic associated diarrhea (AAD). Rapid diagnosis of CDI is essential to prevent hospital spread of infection. The aims were to determine the prevalence of CDI among cases of AAD in Zagazig University Hospitals, identify risk factors, and evaluate real-time polymerase chain reaction (PCR) and enzyme immunoassay (EIA), against toxigenic culture (TC). Stools were collected from 150 patients with AAD. They were tested for TC, toxin A/B EIA, and C. difficile tcdA/tcdB genes. Thirty four toxigenic C. difficile isolates were obtained (22.7%) out of the 150 patients and those patients were considered positive for CDI. On the other hand, 6 non-toxigenic C. difficile isolates were obtained (4%), while culture of the remaining 110 patients (73.3%) did not yield C. difficile. The later 116 patients (77.3%) were considered negative for CDI. Analysis of risk factors revealed that advanced age, prolonged hospitalization, long duration of antibiotic intake, potentiated penicillins, 3rd generation cephalosporins, antibiotic combined therapy, liver cirrhosis, malignancy, proton pump inhibitors, enteral tube feeding, and cancer chemotherapy were significantly associated with CDI. Sensitivitiy, specificitiy, positive predictive value, negative predictive value, and accuracy of real-time PCR against TC were all 100%, however, values of EIA were 79.4%, 100%, 100%, 94.3%, 95.3%, respectively. Conclusion: CDI is an

C. diff is an anaerobic, spore-forming, toxin-producing, gram-positive bacillus that causes infectious diarrhea (Walters & Zuckerman, 2014, p. 24). Since the biggest risk factor is use of antibiotics, avoiding multiple broad-spectrum doses is appropriate in primary prevention. Other interventions that fall under this strategy according to Mitchell, Russo, and Race (2014) include, early initiation of isolating the patient while using appropriate PPE and high levels of personal and environmental cleanliness. In a secondary prevention strategy you would want to test patients that develop diarrhea or loose bowel movements that have been exposed to antibiotics to ensure early detection for treatment. Lastly, in tertiary prevention you would want to focus on the treatment of current C. diff infection. Treatment includes but is not limited to antibiotics (e.g., Flagyl, oral Vancomycin, and Dificid), probiotics, hydration, and possibly surgery depending on the severity of the case. Additionally, adequate surveillance throughout each level of prevention is required to prevent spread or

The well-known toxins of C. difficile is Toxin A and Toxin B. Both toxins are known to cause all sort of symptoms which affect all humans. Symptoms can present itself such as watery diarrhoea and very bad inflammation in people who have this infection.

Most of the public have heard of broad-spectrum drugs, especially in terms of antibiotic resistance, because they fight a wide range of bacteria but also kills normal flora in the gut (Haddox, 2013). The loss of this gut flora can lead to an abnormal growth of harmful bacteria such as clostridium difficile (C-Diff). The four “C” antibiotics that have a high risk for patient to develop C-diff are clindamycin, cephalosporins, coamoxiclav, and ciprofloxacin (Haddox, 2013). These antibiotics have the highest risk of leading to C-diff development, however all antibiotics increase a patient’s likelihood of a C-diff infection. This effect can last up to 12 weeks post antibiotic administration (Haddox, 2013).