Running head: CLOSTRIDIUM DIFFICILE 1 Clostridium difficile Infection Christy Lee Fenton Mountainland Applied Technology College
CLOSTRIDIUM DIFFICILE 2 Clostridium difficile Infection Approximately 200,000 patients are infected with Clostridium difficile (C. difficile) each year. Over one billion dollars is spent each annually for treatment and diagnosis of C. difficile (Keske & Letizia, 2010). C. difficile is the number one cause of nosocomial diarrhea associated illness. It is a normal bacteria found in the intestines. Some antibiotics kill the natural flora in the intestines allowing C. difficile to multiply in large numbers very rapidly causing toxic spore forming gram positive anaerobic bacillus. Most patients acquire C. difficile during a hospital stay, usually while taking antibiotics. C. difficile can survive in the environment for several months and continue to infect anyone who comes in contact with the infected surface (Intermountain Healthcare, 2011; Hamm, 2000). Symptoms, Risk Factors and Diagnosis Some patients with C. difficile present asymptomatic, while more severe cases include colitis, pseudomembranous colitis and toxic megacolon, colonic preformation, sepsis and even death. Symptoms can occur within days of and weeks after the patient is prescribed antibiotics: watery and foul smelling stools, fever of 38 degree Celsius, abdominal pain, distension and cramping, weakness, leukocytosis, and dehydration (Keske & Letizia, 2010).. The majority of patients affected with C. difficile are aged 60 and over. This population typically makes frequent visits to the hospital, has compromised immunity, and is commonly on antibiotics. Half the onsets of C. difficile occur in a long term care facility even though the patient may have acquired the infection during a hospital stay (Keske & Letizia, 2010). The infection rate in older adults is up to ten times greater than younger populations. There are many other factors that contribute to the risk of the C. difficile infection: comorbid medical conditions, use of feeding tubes, and acid suppressant medications (Simor, 2010).
CLOSTRIDIUM DIFFICILE 3 A single stool sample can be tested using one of three most popular tests: cytotoxic assay, enzyme linked immunosorbent assay, or a stool culture. The stool culture is the least reliable diagnostic test. The cytotoxic assay is considered the gold standard in testing for C. difficile. It takes three days to receive results and is 94% to 100% accurate. The enzyme linked immunosorbent assay is the most common test. This test provides results in two to six hours and is 80 % to 90% accurate. If the patient does not present with diarrhea, testing is not recommended (Keske & Letizia, 2010). An endoscopy should only be performed in special cases. This test is more expensive and is only 50% accurate. It takes approximately two hours to complete and is an effective diagnosis of pseudomembranous colitis. The endoscopy is indicated when a patient has in ileus (Keske & Letizia, 2010). Treatment Most cases of C. difficile can be treated by simply removing the antibiotic therapy and providing adequate replacement fluids. Normal colonic bacteria flora will recover and the diarrhea will subside. This treatment is effective in 15 to 25% of the patients. Moderate cases require oral treatment with either metronidazole or vancomycin. Oral metronidazole is readily absorbed in the intestines and is well tolerated. Severe cases, which typically include the presentation of pseudomembranous colitis, severe diarrhea, treatment in a critical care unit, aged patient, fever of 38.3 degree Celsius and pronounced leukocytosis, should be treated with oral vancomycin. Vancomycin is not absorbed or metabolized in a notable amount. It is excreted in the stool and is therefore an ideal treatment. Patients with an ileus or megacolon should be treated with metronidazole intravenously. Possible side effects for treatment with metronidazole include: nausea, vomiting, headache, dizziness, abdominal pain, diarrhea, rashes and
CLOSTRIDIUM DIFFICILE 4 neutropenia. Most cases of C. difficile improve in three to six days. Treatment may continue for 10 to 14 days. Prolonged and tapering doses of oral vancomycin have been reported to be effective in preventing subsequent occurrences (Simor, 2010; Hamm, 2000). Prevention and Interventions Patients being treated with antibiotic therapy, especially in a hospital setting, should be suspect for diagnosis of C. difficile. Patients should be tested as soon as symptoms occur. Patients should be placed in a private room with their own supplies and restroom. Healthcare professionals should use contact precautions: wash hands with soap and water, don gloves and a gown when in direct contact with patient or patient excretions (Simor, 2010). Hand hygiene, utilizing soap and water verses alcohol based products is the highest priority for the patient, the healthcare providers, family and visitors. Hand hygiene combined with gloves is more effective in preventing the carriage of C. difficile and interrupting the transmission. Effective environmental cleaning is essential, during the patient s hospital stay and after the patient is discharged. Most healthcare facilities are taking a bundled approach to the prevention of C. difficile: infection control, antimicrobial management, hand hygiene, implementing barrier precautions and reduced use of antibiotics: cephalosporins, clindamycin and flouroquinolone (Simor, 2010). Most often, the diarrhea will have subsided before the patient goes home. Home intervention should continue: including hand hygiene, completing medication prescribed and continued hydration. Avoid unnecessary use of antibiotics, especially for the treatment of common colds and viruses. If symptoms persist or represent call your doctor immediately (Intermountain Healthcare, 2011).
CLOSTRIDIUM DIFFICILE 5 References Hamm, L. (2000, June). Clostridium difficile. Medscape, 6(6). Retrieved from http://the.medscape.com/viewarticle/410904 Intermountain Healthcare (2011). Lets talk about Clostridium difficile. Salt Lake City, UT: Intermountain Primary Children s Medical Center. 1-3. Keske, L. A., & Letizia, M. J. (2010, November) Clostridium difficile infection: Essential information for nurses. Medsurg Nursing, 19(6). Retrieved from http://www. medscape.com/medline/abstract/21337989 Simior, A. E. (2010), Diagnosis, management, and prevention of Clostridium difficile infection in long-term care facilities: A review. The American Geriatrics Society, 58, 1556-1564. doi: 10.1111/j.1532-5415.2010.02958.x
CLOSTRIDIUM DIFFICILE 6 Jenn, I used the following to determine how to show my references: 1. Hamm (2000): This is a journal article from an online magazine: MedScape. Note article in the URL. I referred to page 200 of the APA book, item #8. 2. Intermountain (2011): Per Jenn in class. 3. Keske (2010): This is a journal article from an online magazine: MEDSURG Nursing. I referred to page 200 of the APA book, item #8. 4. Simor (2010): States it is a journal and it has a DOI. I referred to page 198 in the APA book, item 2. Other Relevant Information: I used C. difficile as the abbreviation of Clostridium difficile. I also bracketed it after the proper use. The articles and CDC web site used it this way. I reviewed page 106-108, 4.25, for my conclusion. The C in Clostridium is capitalized in all articles, on the CDC web site. This particular word is puzzling to me. I referred to page 102 of the APA book, 4.16. It states to capitalize proper names and adjectives and words used as proper nouns. I checked out the Merriam Webster dictionary and this is what I found in: Taxonomic names are used in definitions in this dictionary to provide precise identifications through which defined terms may be pursued in technical writings. Because of their specialized nature, taxonomic names as such are not included as dictionary entries. However, many common names entered in this dictionary have been derived directly from genus names and other taxonomic names, often with little or no modification. In written text it is particularly important to distinguish between a common name and the taxonomic name from which it is derived. In contrast to the styling rules for taxonomic names (discussed below), common names (as "clostridium," "drosophila," and "enterovirus") are not usually capitalized or italicized, and common names derived from genus names can have a plural form even though genus names themselves are never pluralized. I am not sure how you want this or what the best interpretation is. Since three of my articles are
CLOSTRIDIUM DIFFICILE 7 journals and two are of recent date, 2010, I am opting to leave it capitalized. I will wait for your feedback. I also capitalized the C in Celsius per Merriam Webster dictionary. I capitalized the C in Clostridium in the body of the reference information as Christie showed me that is how you approved it in her last paper. Hope I covered everything correctly. Thanks! Christy Lee Fenton