Clostridium difficile A Community Perspective

Helen Oulton

Head of Infection Preventionand Control

Clostridium difficile

• Gram+ spore forming anaerobic bacterium

• Faecal - oral route• Survive in environment

for extended periods• Hands, hands, hands!• Resistant to alcohol

gel• Resistant to some

disinfectants

Symptoms?

•Diarrhoea•Abdominal pain•Blood or mucus in faeces•High temperature•Loss of appetite•Nausea

Risk Factors

• Age • Severe underlying disease• Immunosuppression• Environment with close contact of others e.g. care home• Antibiotic use (previous and current therapy)• Hospitalisation• Chemotherapy• Recent gastrointestinal procedures• Presence of a nasogastric tube• Use of Proton Pump Inhibitors (PPIs)

Clostridium difficile

Patient A

• Day 1. Patient A, a 77 year old male admitted to secondary care ? Urinary sepsis

• Day 2. CT - Pseudomembranous colitis

• Day 3. Patient died. Pseudomembranous colitis recorded on Part 1 of death certificate

Pseudomembranous Colitis

Post Infection Review

• Serious untoward incident – STEIS

• No known Clostridium difficile positive result

• Multiple care services

• Timeline

Loperamide

• Anti motility agent thought to slow down the rate at which the toxins produced by Clostridium difficile are cleared from the gut

Post Infection Review

• No single electronic access to patient records

• Patient at increased risk of Clostridium difficile infection (CDI) but CDI as cause of diarrhoea not considered

• Use of Loperamide

• Faecal sample not obtained in line with PHE guidance

• Communication between agencies

Contributory Factors

• Multiple courses of antibiotic therapy

• Previous episodes diarrhoea related to antibiotic therapy treated with Loperamide (self-administered)

• Long term Proton Pump Inhibitors (PPI’s)

• Delay in diagnosis/treatment as patient declined admission to hospital

Remember!

• Diarrhoeal illness is a common cause of consultation within primary care with the majority of cases responding to simple interventions e.g. oral rehydration, withdrawal of medication

HOWEVER………………………

Be Clostridium difficile Aware

• Know the risk factors

• Confirm antibiotic history before prescribing

• Avoid anti motility drugs

• Prompt faecal sampling

• Rigorous infection prevention and control standards

The Future?

Any questions?