Clostridium difficile: A Difficult Microbe

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A slideshow about the impact, signs/symptoms, and treatment of C. diff infections. Presented to pharmacy staff at the University of Rochester Medical Center in February 2010.

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  • Clostridium difficile: A Difficult Microbe

    1. 1. Clostridium difficile: Chilla E. Goncz, PharmD Candidate PGY-1 Residency Applicant a difficult microbe Nova Southeastern University
    2. 2. Objectives To explain the pathogenesis, as well as signs and symptoms of C. difficile infections To discuss risk factors and prevention strategies for C. difficile infections To describe diagnostic methods and treatment options for C. difficile infections
    3. 3. Why should you care about C. difficile?
    4. 4. Longer hospital stays, higher rates of readmission and increased healthcare costs are all consequences of C. difficile infections McFarland LV. Renewed interest in a difficult disease: Clostridium difficile infections—epidemiology and current treatment strategies. Curr Opin Gastroenterol. 2009 Jan;25(1):24-35.
    5. 5. C. difficile-related healthcare costs the US $3.2 billion/year McFarland LV. Renewed interest in a difficult disease: Clostridium difficile infections—epidemiology and current treatment strategies. Curr Opin Gastroenterol. 2009 Jan;25(1):24-35.
    6. 6. Rates of C. difficile are significantly greater in the northeastern region of the U.S. than in the midwestern, southern, and western regions Halsey J. Current and future treatment modalities for Clostridium difficile-associated disease. Am J Health Syst Pharm. 2008 Apr 15;65(8):705-15.
    7. 7. C. difficile has a set of characteristics that allow it to inflict extraordinary damage
    8. 8. Toxin A, Toxin B, and CDT make a powerful cytotoxic team Toxin B Toxin A CDT
    9. 9. Signs and symptoms range in severity and generally involve the intestinal tract
    10. 10. Risk factors include host, intestinal flora, and exposure time components
    11. 11. Prevention strategies target... appropriate use of antibiotics frequent hand washing
    12. 12. Diagnostic methods vary in sensitivity, specificity, time, and cost
    13. 13. Treatment strategies focus on discontinuation of the offending antibiotic and initiation of metronidazole or vancomycin
    14. 14. Fulminant C. difficile infections may require surgical intervention or IVIG
    15. 15. Refractory cases may require various unique approaches
    16. 16. Highly promising C. difficile vaccines and toxin-binding agents are on the horizon...
    17. 17. References Bartlett JG. New antimicrobial agents for patients with clostridium difficile infections. Curr Infect Dis Rep. 2009 Jan;11(1):21-8. Halsey J. Current and future treatment modalities for Clostridium difficile-associated disease. Am J Health Syst Pharm. 2008 Apr 15;65(8):705-15. Leffler DA, Lamont JT. Treatment of clostridium difficile-associated disease. Gastroenterology. 2009 May;136(6): 1899-912. Epub 2009 May 7. Martin S, Jung R. Gastrointestinal Infections and Enterotoxigenic Poisonings. In: DiPiro JT, Talbert RL,Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 7th ed. New York, NY: McGraw-Hill;2008:1863-4. McFarland LV. Renewed interest in a difficult disease: clostridium difficile infections—epidemiology and current treatment strategies. Curr Opin Gastroenterol. 2009 Jan;25(1):24-35. Metronidazole and Vancomycin. In: Lexi-Drugs [database for PDA]. Version 1.5.1(116). Hudson (OH): Lexi- Comp, Inc. c2010 [updated 2010 Feb 15; cited 2010 Feb 15]. Available from www.lexi.com/individuals/iphone. Schwan C, Stecher B, Tzivelekidis T, van Ham M, Rohde M, Hardt WD, et al. Clostridium difficile toxin CDT induces formation of microtubule-based protrusions and increases adherence of bacteria. PLoS Pathog. 2009 Oct;5(10):e1000626. Epub 2009 Oct 16. Sunenshine RH, McDonald LC. Clostridium difficile-associated disease: new challenges from an established pathogen. Cleve Clin J Med. 2006 Feb;73(2):187-97.

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