guidance for proven or suspected c. difficile associated diarrhoea (cdad)

Guidance for Proven or Suspected C. difficile associated diarrhoea (CDAD) Constipation with overflow diarrhoea (make sure PR done), laxatives and other common causes of diarrhoea have been excluded Does patient have risk factors for CDAD? History of use (< 3m) or current use of an antibiotic Discharged from healthcare facility in the last 3 months Use of PPI Increasing age especially >65y Surgical procedure (in particular bowel procedures) Send stool for C. difficile toxin Inform Infection Control Team Isolate patient in single room Designated toilet or commode Review PPI Stop antimicrobial treatment if possible Stop laxative Hand hygiene with soap and water Wear gloves and disposable apron Toxin -ve Toxin +ve Continue with guidance Discontinue C. difficile guidance or if index of suspicion high seek ID referral Patient has non-severe CDAD Treat with oral metronidazole 400mg t.d.s. for 10-14 days Rehydrate patient Daily assessment of patient with mild to moderate disease: Observe bowel movement, symptoms (WBC and hypotension) and fluid balance. If condition doesn’t improve after 3-5 days of treatment with metronidazole, patient should be switched to treatment with vancomycin (125mg q.d.s. for a further 10-14 days) Treat with oral vancomycin 125mg q.d.s. for 14 days Rehydrate patient and consider referral to hospital or healthcare facility if patient at home Daily assessment of patient with severe disease: Observe bowel movement, symptoms (WBC and hypotension) and fluid balance. Surgery – Consult and AXR and CT scanning; consider PMC, toxic megacolon, ileus or perforation If ileus is detected add 500mg metronidazole i.v. t.d.s. until ileus is resolved Patient has severe CDAD Contact Details Infection control team via switchboard Public health via NWH switch board if care home “On call” duty microbiologist: 4039 Ninewells or via switchboard 5315 Perth Royal Refer to Infectious Disease Yes UNDERTAKE SEVERITY ASSESSMENT Suspicion of Pseudomembranous colitis (PMC) or toxic megacolon or ileus OR two or more of the following severity markers Colonic dilatation in CT scan or AXR >6cm (if available) WCC >15 cells/mm 3 Creatinine >1.5 x baseline Albumin <25 g/l For recurrent (3 or more episodes) CDAD seek Specialist ID/Micro advice Antimicrobial Management Group October 2010 Review October 2011 Yes No

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Constipation with overflow diarrhoea (make sure PR done), laxatives and other common causes of diarrhoea have been excluded. Does patient have risk factors for CDAD? History of use (< 3m) or current use of an antibiotic Discharged from healthcare facility in the last 3 months Use of PPI - PowerPoint PPT Presentation

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Guidance for Proven or Suspected C. difficile associated diarrhoea (CDAD)

Constipation with overflow diarrhoea (make sure PR done), laxatives and other common causes of diarrhoea have been excluded

Does patient have risk factors for CDAD?History of use (< 3m) or current use of an antibioticDischarged from healthcare facility in the last 3 monthsUse of PPIIncreasing age especially >65ySurgical procedure (in particular bowel procedures)

Send stool for C. difficiletoxin

Inform InfectionControl Team Isolate patient

in single roomDesignated toilet

or commode

Review PPIStop anti-

microbial treatment if possible

Stop laxative

Hand hygienewith soap and

waterWear gloves

and disposable apron

Toxin -ve Toxin +ve

Continue with guidance

Discontinue C. difficileguidance or if indexof suspicion high seek ID referral

Patient has non-severe CDAD

Treat with oral metronidazole 400mg t.d.s. for 10-14 days

Rehydrate patient

Daily assessment of patient with mild to moderate disease:

Observe bowel movement, symptoms (WBC and hypotension) and fluid balance.

If condition doesn’t improve after 3-5 days of treatment with metronidazole, patient should be switched to treatment with vancomycin (125mg q.d.s. for a further 10-14 days)

Treat with oral vancomycin 125mg q.d.s. for 14 days

Rehydrate patient and consider referral to hospital or healthcare facility if patient at home

Daily assessment of patient with severe disease:

Observe bowel movement, symptoms (WBCand hypotension) and fluid balance.

Surgery – Consult and AXR and CT scanning; consider PMC, toxic megacolon, ileus orperforation

If ileus is detected add 500mg metronidazole i.v. t.d.s. until ileus is resolved

Patient has severe CDAD

Contact Details

Infection control team via switchboard

Public health via NWH switch board if care home

“On call” duty microbiologist: 4039 Ninewells or via switchboard

5315 Perth Royal

“On call” ID: 5075

Refer to Infectious Disease

Yes

UNDERTAKE SEVERITY ASSESSMENTSuspicion of Pseudomembranous colitis

(PMC) or toxic megacolon or ileus OR two or more of the following severitymarkersColonic dilatation in CT scan or AXR >6cm (if available)WCC >15 cells/mm3

Creatinine >1.5 x baselineAlbumin <25 g/l

For recurrent (3 or moreepisodes) CDAD seekSpecialist ID/Micro advice

Antimicrobial Management GroupOctober 2010

Review October 2011

YesNo

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