C. diff presentation
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C. diff presentation C. diff presentation Presentation Transcript

  • Clostridium difficile
  • Incidence and Severity
    • During the mid- and late 1990s, in the US, the incidence was 30 to 40 per 100,000
    • Incidence increased to 50 per 100,000 in 2001 to 84 per 100,000 in 2005.
    • In Britain C. diff as the primary cause of death increased from 499 in 1999 to 3393 in 2006
  • Metro vs vanc
    • Metronidazole or oral vancomycin have the treatment of choice since the late 1970s
    • Before 2000, failure rates were around 3% for both therapies
    • But since, there have been significant increases in flagyl failure (18.2%)
    • Metronidazole is the first line treatment for mild infections, but vancomycin should be used for severe treatment
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  • Management of Recurrence
    • Ultimate goal of treatment is to discontinue all antibiotics
    • Not all patients in whom recurrent diarrhea develops have recurrent C. diff
      • Posinfectious irritable bowel
      • Microscopic colitis
    • Positive toxin with minimal or no symptoms should not prompt treatment
    • Since C. diff is rarely resistant to metronidazole or vancomycin, diarrhea despite therapy should increase suspicion for another etiology
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