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1
Clostridium
difficile
Elizabeth Boldon, RN, MSN
Elizabeth Boldon is a Nurse Education
Specialist at Mayo Clinic in Rochester,
Minnesota. She received a BSN from
Allen College in Waterloo, Iowa in 2002
and an MSN with a focus in education
from the University of Phoenix in 2008.
She has bedside nursing experience in
medical neurology and the neuroscience
ICU.
Abstract
Clostridium difficile infection (CDI) is a major cause of infectious disease
concern in the United States. It is the associated with hospital-acquired
intestinal inflammation and diarrhea and, most commonly, with normal
intestinal flora disruption due to poor prescribing practices of antibiotics. It
has been reported that antibiotics prescribed in hospitals are often
unnecessary or incorrect. Using infection control recommendations and more
careful antibiotic use can prevent clostridium difficile infection. The risk of
CDI associated with antibiotic use and other risk factors, including disease
recognition, treatment and prevention are discussed.
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Continuing Nursing Education Course Planners
William A. Cook, PhD, Director, Douglas Lawrence, MA, Webmaster,
Susan DePasquale, MSN, FPMHNP-BC, Lead Nurse Planner
Policy Statement
This activity has been planned and implemented in accordance with the
policies of NurseCe4Less.com and the continuing nursing education
requirements of the American Nurses Credentialing Center's Commission on
Accreditation for registered nurses. It is the policy of NurseCe4Less.com to
ensure objectivity, transparency, and best practice in clinical education for
all continuing nursing education (CNE) activities.
Continuing Education Credit Designation
This educational activity is credited for 2 hours. Nurses may only claim credit
commensurate with the credit awarded for completion of this course activity.
Statement of Learning Need
Nurses need to recognize and stay informed of the risk factors, symptoms,
diagnosis, treatment and prevention of clostridium difficile. Importantly, C.
difficile is caused by normal intestinal flora disruption due to poor prescribing
practices of antibiotics. Nurses can identify and educate patients and peers
of the risk of antibiotic prescribing and other risk factors associated with C.
difficile morbidity and mortality.
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Course Purpose
To provide nursing professionals with knowledge to care for patients with
clostridium difficile, and to promote prevention strategies of disease
occurrence and recurrence.
Target Audience
Advanced Practice Registered Nurses and Registered Nurses
(Interdisciplinary Health Team Members, including Vocational Nurses and
Medical Assistants may obtain a Certificate of Completion)
Course Author & Planning Team Conflict of Interest Disclosures
Elizabeth Boldon, RN, MSN, William S. Cook, PhD,
Douglas Lawrence, MA, Susan DePasquale, MSN, FPMHNP-BC –
all have no disclosures
Acknowledgement of Commercial Support
There is no commercial support for this course.
Activity Review Information
Reviewed by Susan DePasquale, MSN, FPMHNP-BC
Release Date: 2/15/2016
Termination Date: 9/30/2018
Please take time to complete a self-assessment of knowledge, on
page 4, sample questions before reading the article.
Opportunity to complete a self-assessment of knowledge learned
will be provided at the end of the course.
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1. Each year, more than _____________ people get sick from C.
difficile.
a. 1/4th million
b. 1/3rd million
c. half million
d. None of the above
2. Complications of C. difficile infections include:
a. dehydration
b. hypotension
c. kidney failure
d. All of the above
3. Standard treatment for C. diff is a _________ day course of
another antibiotic.
a. 5 - 7
b. 10 – 14
c. 20 – 30
d. > 30
4. For more severe and recurrent cases, _____________ , may be
prescribed
a. ampicillin
b. flagyl
c. vancomycin
d. Answers a and b above
5. True/False. Research has shown FMT has a success rate higher
than 50 percent for treating C. difficile infections.
a. True
b. False
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Introduction
Clostridium difficile infection (CDI), also called C. difficile or C. diff, is an
important cause of concern for health professionals in the United States due
the infectious disease morbidity and mortality rates reported with its
occurrence. It has been estimated (in 2011) that CDI had caused almost half
a million infections in the U.S. population. Approximately 83,000 of the
patients who developed CDI experienced at least one recurrence and 29,000
individuals died within 30 days of the initial diagnosis.1
Poor prescribing practices put patients at risk for C. difficile infections. More
than half of all hospitalized patients will receive an antibiotic at some point
during their hospital stay, but studies have shown that 30 - 50% of
antibiotics prescribed in hospitals are unnecessary or incorrect. C. difficile
infections can be prevented by using infection control recommendations and
more careful antibiotic use.1
What Is Clostridium difficile?
Clostridium difficile is a bacterium that can cause symptoms ranging from
diarrhea to life-threatening inflammation of the colon. Illness from C. difficile
most commonly affects older adults in hospitals or in long-term care facilities
and typically occurs after use of antibiotic medications. However, studies
show increasing rates of C. difficile infection among people traditionally not
considered high risk, such as younger, healthier individuals without a history
of antibiotic use or exposure to healthcare facilities. Each year, more than a
half million people get sick from C. diff. In recent years, C. difficile infections
have become more frequent, severe and difficult to treat.2
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Symptoms of Clostridium difficile
Some people carry the bacterium C. difficile in their intestines but never
become sick, though they can still spread the infection. Clostridium difficile
illness usually develops during or within a few months after a course of
antibiotics.2
Mild to moderate infection
The most common symptoms of mild to moderate C. difficile infection are
listed below. These are:

Watery diarrhea three or more times a day for two or more days

Mild abdominal cramping and tenderness
Severe infection
In severe cases, people tend to
become dehydrated and may need
hospitalization. Clostridium difficile
causes the colon to become inflamed
(colitis) and sometimes may form
patches of raw tissue that can bleed
or produce pus (pseudomembranous
colitis). Signs and symptoms of
severe infection include:2

Watery diarrhea 10 to 15 times
a day

Abdominal cramping and pain, which may be severe
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
Fever

Blood or pus in the stool

Nausea

Dehydration

Loss of appetite

Weight loss

Swollen abdomen

Kidney failure

Increased white blood cell count
Causes of Clostridium difficile
Clostridium difficile bacteria are found throughout the environment — in soil,
air, water, human and animal feces, and food products, such as processed
meats. A small number of healthy people naturally carry the bacteria in their
large intestine without experiencing ill effects from the infection.
Most commonly associated with healthcare, C. difficile infection occurs in
hospitals and other healthcare facilities where a much higher percentage of
people carry the bacteria. However, studies show increasing rates of
community-associated C. difficile infection, which occurs among populations
traditionally not considered at high risk, such as children and people without
a history of antibiotic use or recent hospitalization.2
Clostridium difficile bacteria is passed in feces and spread to food, surfaces
and objects when people who are infected are negligent in washing their
hands thoroughly. The bacteria produce spores that can persist in a room for
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weeks or months. If someone touches a surface contaminated with C.
difficile, they may then unknowingly swallow the bacteria.
The intestines contain millions of bacteria, many of which help protect the
body from infection. However, when an individual is taking an antibiotic to
treat an infection, the drug can destroy some of the normal, helpful bacteria
as well as the bacteria causing the illness. Without enough healthy bacteria,
C. difficile can quickly grow out of control. Once established, C. difficile can
produce toxins that attack the lining of the intestine. The toxins destroy cells
and produce patches (plaques) of inflammatory cells and decaying cellular
debris inside the colon and cause watery diarrhea.2
Emergence of a new strain
An aggressive strain of C. difficile has
emerged that produces far more toxins than
other strains do. The new strain may be
more resistant to certain medications and
has shown up in people who have not been
in the hospital or taken antibiotics. This
strain of C. difficile has caused several
outbreaks of illness since 2000.2
Risk Factors for Clostridium difficile
Although people — including children — with no known risk factors have
become sick from C. difficile, certain factors increase the risk. These risk
factors are briefly outlined below.
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Taking antibiotics or other medications
Medication-associated risk factors relate to a variety of scenarios. Examples
of medication-associated risk factors include:

Currently taking or having recently taken antibiotics

Taking broad-spectrum antibiotics that target a wide range of bacteria

Using multiple antibiotics

Taking antibiotics for a long time

Taking medications to reduce stomach acid, including proton pump
inhibitors (PPIs)
Staying in a healthcare facility
The majority of C. difficile cases occur
in, or after exposure to, healthcare
settings — including hospitals, nursing
homes and long-term care facilities —
where germs spread easily, antibiotic
use is common and people are
especially vulnerable to infection. In
hospitals and nursing homes, C. difficile
spreads mainly on hands from person
to person, but also on cart handles,
bedrails, bedside tables, toilets, sinks,
stethoscopes, thermometers — even
telephones and remote controls.2
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Having a serious illness or medical procedure
Having a serious illness, such as inflammatory bowel disease or colorectal
cancer, or a weakened immune system as a result of a medical condition or
treatment (such as chemotherapy), cause people to be more susceptible to a
C. difficile infection. The risk of C. difficile infection is also greater in those
who have had abdominal surgery or a gastrointestinal procedure.
Older age is also a risk factor for C.
difficile infection. In one study, the risk
of becoming infected with C. difficile was
10 times greater for people age 65 and
older compared with younger people.
After having a previous C. difficile
infection, the chances of having a
recurring infection can be up to 20
percent, and the risk increases further
with every subsequent infection.2
Diagnosis of Clostridium difficile
Medical providers often suspect C. difficile in anyone with diarrhea who has
recently taken antibiotics or when diarrhea develops a few days after
hospitalization. In such cases, the following tests may be performed:
Stool tests
Toxins produced by C. difficile bacteria can usually be detected in a sample
of stool. Several main types of lab tests exist, and they include:
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
Enzyme immunoassay:
Most labs use the enzyme immunoassay (EIA) test, which is faster
than other tests, but is not sensitive enough to detect many infections
and has a higher rate of falsely normal tests.

Polymerase chain reaction:
This sensitive molecular test can rapidly detect the C. difficile toxin B
gene in a stool sample and is highly accurate. It is now being adapted
by several laboratories and becoming more widely available.

Cell cytotoxicity assay:
A cytotoxicity test looks for the effects of the C. difficile toxin on
human cells grown in a culture. This type of test is sensitive, but it is
less widely available, more cumbersome to do and requires more than
24 to 48 hours for test results. Some hospitals use both the EIA test
and cell cytotoxicity assay to ensure accurate results.
Testing for C. difficile is unnecessary in the absence of diarrhea or watery
stools.2
Colon examination
In rare instances, to help confirm a diagnosis of C. difficile infection, a care
provider may examine the inside of the colon. A colonic examination,
through a flexible sigmoidoscopy or colonoscopy procedure, involves
inserting a flexible endoscope with a small camera on one end into the colon
to look for areas of inflammation and pseudomembranes. This procedure
allows the endoscopist to remove tissue samples through biopsy or snare
instruments for laboratory (pathology) testing.
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Imaging tests
If a medical provider is concerned about possible complications of C. difficile,
he or she may order an abdominal X-ray or a computerized tomography
(CT) scan, which provides images of the colon. The scan can detect the
presence of complications such as thickening of the colon wall, expanding of
the bowel, or more rarely, a perforation in the lining of the colon.
Complications of Clostridium difficile
Complications of C. difficile infections include the following conditions.2

Dehydration:
Severe diarrhea can lead to a significant loss of fluids and electrolytes.
This makes it difficult for the body to function normally and can cause
severe hypotension.

Kidney failure:
In some cases, dehydration can occur so quickly that kidney function
rapidly deteriorates (kidney failure).

Toxic megacolon:
In situations of toxic megacolon, the affected patient becomes unable
to expel gas and stool, causing the colon to become greatly distended
(hence, the term megacolon). Left untreated, the colon can rupture,
causing bacteria from the colon to enter the abdominal cavity. A
ruptured colon requires emergency surgery and may be fatal.

Bowel Perforation:
A bowel perforation is rare and results from extensive damage to the
lining of the large intestine. A perforated bowel can spill bacteria from
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the intestine into the abdominal cavity, leading to a life-threatening
infection (peritonitis).

Death:
Even mild to moderate C. difficile infections can quickly progress to a
fatal disease if not treated promptly.
Treatment Of Clostridium difficile
The first step in treating C. difficile is to stop taking the antibiotic that
triggered the infection, when possible. Depending on the severity of the
infection, treatment may include the following medical and surgical
interventions.
Antibiotics
Ironically, the standard treatment for C. difficile is a 10 - 14 day course of
another antibiotic. These antibiotics keep C. difficile from growing, which
treats diarrhea and other complications.
For mild to moderate infection, medical providers usually prescribe
metronidazole (Flagyl), taken by mouth. Metronidazole is not approved by
the U.S. Food and Drug Administration (FDA) for C. difficile infection, but has
been shown to be effective in mild to moderate infection. Side effects of
metronidazole include nausea and a bitter taste. For more severe and
recurrent cases, vancomycin (Vancocin), also taken by mouth, may be
prescribed.
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Another oral antibiotic, fidaxomicin (Dificid), has been approved to treat C.
difficile. In one study, the recurrence rate of C. difficile in people who took
fidaxomicin was lower than among those who took vancomycin. However,
fidaxomicin costs considerably more than metronidazole and vancomycin.
Common side effects of vancomycin and fidaxomicin include abdominal pain
and nausea.2
Surgery
For people with severe pain, organ failure
or inflammation of the lining of the
abdominal wall, surgery to remove the
diseased portion of the colon may be the
only option. Recurrent infection and
situations when surgery may be
considered are outlined below.
Recurrent infection
Up to 20 percent of people with C. difficile
get sick again, either because the initial infection never went away or
because they're reinfected with a different strain of the bacteria. But after
one or more recurrences, rates of further recurrence increase up to 65
percent.2
The risk of recurrence is higher for the following individuals.

People older than 65
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
Those taking other antibiotics for a different condition while being
treated with antibiotics for C. difficile infection

Those having a severe underlying medical disorder, such as chronic
kidney failure, inflammatory bowel disease or chronic liver disease.
Medical Treatment for Recurrent CDI
The medical treatment for recurrent C. difficile infection may include the
following interventions.
Antibiotics
Antibiotic therapy for recurrence of C. difficile infection may involve one or
more courses of a medication (typically vancomycin), a gradually tapered
dose of medication or an antibiotic given once every few days, a method
known as a pulsed regimen. For a first recurrence, the effectiveness of
antibiotic therapy is around 60 percent and further declines with each
subsequent recurrence.
Fecal microbiota transplant (FMT)
Also known as a stool transplant, fecal microbiota transplant, or FMT, is
emerging as an alternative strategy for treating recurrent C. difficile
infections. Though not yet approved by the FDA, clinical studies of FMT are
currently underway.
Fecal microbiota transplant restores healthy intestinal bacteria by placing
another person's (donor's) stool in the colon, using a colonoscope or
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nasogastric tube. Donor stools are carefully and repeatedly screened for
parasites, viruses, bacteria and certain antibodies before being used for an
FMT. Research has shown FMT has a success rate higher than 90 percent for
treating C. difficile infections. One small, randomized, controlled trial
stopped early because the results were so positive, with a 94 percent
success rate overall.2
Probiotics
Probiotics are organisms, such as
bacteria and yeast, which help restore a
healthy balance to the intestinal tract.
Yeast called Saccharomyces boulardii, in
conjunction with antibiotics, might help
prevent further recurrent C. difficile
infections.
Prevention Of Clostridium difficile
Prevention of C. difficile transmission is especially challenging because the
organism forms spores, which can persist on environmental surfaces for
months and are resistant to commonly used hospital cleaning agents and
alcohol-based hand gels. Thus, prevention and control of C. difficile requires
a number of interventions. This was illustrated in a report of a C. difficile
hypervirulent strain outbreak; the outbreak was successfully controlled with
introduction of successive interventions and through the guidance of ongoing
surveillance.
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Statewide programs and national initiatives emphasizing public reporting,
antibiotic stewardship, and infection control measures have also
demonstrated successful prevention.3
To help prevent the spread of C. difficile, hospitals and other healthcare
facilities follow strict infection-control guidelines. A detailed practice
recommendation for prevention of C. difficile infection in acute-care hospital
settings from the Society for Healthcare Epidemiology of America and the
Infectious Diseases Society of America is available. The recommendations of
each are summarized briefly here.
Surveillance
Rates of C. difficile infection should be tracked using standard surveillance
definitions and be grouped into three hospital facility (HCF) and community
categories: (1) HCF-onset, HCF-associated; (2) community-onset, HCFassociated; and, (3) community-associated. Such data can be compared
with other facilities and used to evaluate trends within the same facility.
Rising rates or rates above published benchmarks should prompt further
investigation and intervention.
Since 2013, all United States hospitals participating in the Centers for
Medicare & Medicaid Services' Inpatient Prospective Payment System Quality
Reporting Program are required to report facility-wide C. difficile events
using the National Healthcare Safety Network (NHSN); and, public reporting
of hospital rates began in 2014 at the Hospital Compare website. As of 2015,
all long-term acute care hospitals are required to report facility-wide C.
difficile events.3
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Prevention Strategies
Early detection and isolation
Early detection of C. difficile with rapid implementation of contact
precautions is essential for preventing transmission. It requires vigilant
screening for new onset diarrhea in patients at risk and rapid, accurate
testing.
Contact precautions
Patients with suspected or proven C. difficile infections should be placed on
contact precautions, including assignment to a single room with dedicated
toileting facilities or cohorting with other infected patients. Gloves and
gowns should be donned upon room entry and removed prior to exiting the
room. When cohorting is necessary, gowns and gloves should be removed
and hand hygiene performed when moving from one patient to the other. It
may be reasonable to continue contact precautions beyond the duration of
diarrhea, since persistent stool shedding of C. difficile spores is common;
further study is needed on this.3
Hand hygiene
Healthcare personnel should wash their hands with soap and water when
caring for C. diff patients. This is particularly important in the setting of a C.
difficile outbreak. Alcohol-based hand rub (ABHR) does not eradicate C.
difficile spores.
Hand washing with soap and water involves vigorous mechanical scrubbing
and rinsing, so it is more effective than ABHR for physical removal of
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bacterial spores. However, bacterial spore removal through soap and water
hand washing is less effective than ABHR inactivation of vegetative (i.e.,
non-spore forming) bacteria. Thus, adherence to glove use in the care of
symptomatic patients is critically important for preventing transmission of C.
difficile.
Patients with C. difficile infection should also be encouraged to wash hands
with soap and water. In particular, patients should wash their hands after
using the commode, before eating, and when hands are visibly soiled.3
Environmental Cleaning
Clostridium difficile spores can survive on dry surfaces for up to several
months and resist killing by standard disinfectants. Therefore, careful
attention to environmental cleaning is critical for reducing surface
contamination. One study on a bone marrow transplant unit noted that
switching to 1:10 hypochlorite solution from quaternary ammonium was
effective for reducing C. difficile infection rates, from 8.6 to 3.3 cases per
1000 patient-days.3
A disinfectant with a C. difficile sporicidal label that has been registered with
the Environmental Protection Agency (EPA) should be considered for
disinfection of patient rooms and bathroom. Some sporicidal agents can
cause caustic damage to equipment surfaces and serve as an irritant for
patients and healthcare personnel. These issues should be considered in the
selection and implementation of such agents in healthcare facilities as well
as other public settings.
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Multiuse medical equipment such as blood pressure cuffs, stethoscopes, and
thermometers can serve as vectors for transmission of C. difficile. When
possible, disposable equipment should be used; otherwise, such equipment
should be dedicated to a single patient with C. difficile infection. Equipment
that must be shared between patients should be cleaned and disinfected
with a sporicidal agent between uses.3
Chlorhexidine Bathing
Chlorhexidine (CHG) bathing may reduce hospital-acquired C. difficile. This
was illustrated in a study including administration of more than 68,000 CHG
baths over an 18-month period, during which the incidence of C. difficile
decreased with bathing daily or three times weekly compared with a oneyear baseline observation period.3
Antibiotic Stewardship
Administration of antibiotics disrupts the intestinal microbiota and has been
definitively linked to both colonization and disease caused by C. difficile.
Antibiotic use increases the risk for developing C. difficile by 7- to 10-fold
during and up to one month after treatment and by approximately threefold
for two months thereafter. Targeted restriction of a particular antibiotic
agent or class of agents can facilitate control of hospital outbreaks and
reduce C. difficile rates in the community.3
Antibiotics frequently associated with increased C. difficile risk include
clindamycin, fluoroquinolones, cephalosporins, and penicillins. These are
outlined briefly below.
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Clindamycin
Clindamycin restriction has been followed by rapid reductions in C. difficile
cases in several outbreaks. Similar findings have been observed in outbreaks
caused by the highly clindamycin-resistant J strain. In one study, for
example, a policy requiring infectious disease physician approval for
clindamycin use led to reduction in CDI cases (from 11.5 to 3.3 cases per
month).3
Fluoroquinolone
Fluoroquinolone use has been associated with outbreaks caused by the
hypervirulent NAP1/BI/027 strain. Restriction of all fluoroquinolones may be
required for effective control in such circumstances. In one study,
elimination of fluoroquinolone use was associated with a reduction in C.
difficile cases and in the proportion of cases due to the NAP1/BI/027 strain.
Third-generation Cephalosporins
Restriction of third-generation cephalosporins has been successful in
reducing C. diff rates. Other studies have noted associations between
formulary restrictions and reduced C. difficile rates by limiting antibiotics to
penicillin, trimethoprim-sulfamethoxazole, and aminoglycosides in the
setting of an outbreak.
Avoiding Gastric Acid Suppression
Whenever possible, gastric acid suppression should be avoided. Proton pump
inhibitors are a widely used medication to control symptoms of gastric
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hyperacidity and reflux, which has led to adverse effects associated with C.
difficile.
Summary
The average human digestive tract is home for as many as 1,000 species of
microorganisms. Most of them are harmless - or even helpful - under normal
circumstances. But when something upsets the balance of these organisms
in the gut, otherwise harmless bacteria can grow out of control and cause
illness. One of the worst offenders is the C. difficile bacterium. As the C.
difficile bacteria overgrow they release toxins that attack the lining of the
intestines, causing a potentially fatal condition.
This article has described this condition, as well as the symptoms, causes,
risk factors, diagnosis, complications, treatment and prevention. Clostridium
difficile is a serious, potentially life-threatening infection that can be treated
and prevented by careful infection control practices.
Please take time to help NurseCe4Less.com course planners evaluate
the nursing knowledge needs met by completing the self-assessment
of Knowledge Questions after reading the article, and providing
feedback in the online course evaluation.
Completing the study questions is optional and is NOT a course
requirement.
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1. Approximately _________ of patients who developed C.
difficile experienced at least one recurrence:
a. 25,000
b.40,000
c. 65,000
d.83,000
2.
Studies show that _________ % of antibiotics prescribed in
hospitals are unnecessary or incorrect.
a. 15 – 20
b. 25 – 35
c. 30 – 50
d. > 50
3.
Each year, more than _____________ people get sick from C.
difficile.
a. 1/4th million
b. 1/3rd million
c. half million
d. None of the above
4.
Signs and symptoms of severe C. difficile infection include:
a. fever
b. blood or pus in the stool
c. dehydration and weight loss
d. All of the above
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5.
The antibiotics that most often lead to C. difficile infections
include:
a. fluoroquinolones
b. cephalosporins
c. clindamycin and penicillins
d. All of the above
6.
Complications of C. difficile infections include:
a. dehydration
b. hypotension
c. kidney failure
d. All of the above
7.
For mild to moderate infection, medical providers usually
prescribe
a. Penicillin
b. Vancomycin
c. Metronidazole (Flagyl)
d. Either a or b above
8.
___________ of people with C. difficile get sick again
a. 10 percent
b. 20 percent
c. 30 percent
d. 50 percent
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9.
After one or more recurrences, rates of further recurrence of C.
difficile increase up to ________________.
a. 20 percent
b. 35 percent
c. 50 percent
d. 65 percent
10. True/False. The goal of FMT is to restore healthy intestinal
bacteria.
a. True
b. False
11. Research has shown FMT has a success rate higher than ______
percent for treating C. difficile infections.
a. 35
b. 50
c. 90
d. None of the above
12. Suspected or proven C. difficile cases should be placed on
_____________
a. isolation
b. contact precaution
c. reverse isolation
d. Answers a and c above
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13. C. difficile spores can survive on dry surfaces for up to
a. Days
b. Weeks
c. Several months
d. None of the above
14. True/False. Alcohol-based hand rub (ABHR) eradicates C.
difficile spores.
a. True
b. False
15. Removal through soap and water hand washing is less effective
than ABHR inactivation of vegetative (i.e., non-spore forming)
bacteria.
a. True
b. False
Correct Answers:
1.
Approximately _________ of patients who developed C. difficile
experienced at least one recurrence:
Correct Answer: 83,000
2.
Studies show that _________ % of antibiotics prescribed in hospitals
are unnecessary or incorrect.
Correct Answer: 30 – 50
3.
Each year, more than _____________ people get sick from C. difficile.
Correct Answer: half million
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4.
Signs and symptoms of severe C. difficile infection include:
Correct Answer: All of the above
5.
The antibiotics that most often lead to C. difficile infections include:
Correct Answer: All of the above
6.
Complications of C. difficile infections include:
Correct Answer: All of the above
7.
For mild to moderate infection, doctors usually prescribe
Correct Answer: Metronidazole (Flagyl)
8.
___________ of people with C. difficile get sick again
Correct Answer: 20 percent
9.
After one or more recurrences, rates of further recurrence of C. difficile
increase up to ________________.
Correct Answer: 65 percent
10. True/False. The goal of FMT is to restore healthy intestinal bacteria.
Correct Answer: True
11. Research has shown FMT has a success rate higher than ______
percent for treating C. difficile infections.
Correct Answer: 90
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12. Suspected or proven C. difficile cases should be placed on
_____________
Correct Answer: contact precaution
13. C. difficile spores can survive on dry surfaces for up to
Correct Answer: Several months
14. True/False. Alcohol-based hand rub (ABHR) eradicates C. difficile spores.
Correct Answer: False
15. Removal through soap and water hand washing is less effective than
ABHR inactivation of vegetative (i.e., non-spore forming) bacteria.
Correct Answer: True
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References Section
The reference section of in-text citations include published works intended as
helpful material for further reading. Unpublished works and personal
communications are not included in this section, although may appear within
the study text.
1. Clostridium difficile infection (2015). Centers for Disease Control and
Prevention. Retrieved September 10, 2015 from www.cdc.gov
2. C. difficile infection (2013). Mayo Foundation for Medical Education and
Research. Retrieved September 18, 2015 from www.mayoclinic.org
3. Gould, C. & McDonald, L.C. (2015.) Clostridium difficile infection:
Prevention and control in Calderwood, S.B. (Ed.), UpToDate. Waltham,
Mass: UpToDate. Retrieved September 19, 2015 from www.uptodate.com
Additional Helpful Resources:
C diff. (2015.) WebMD. Retrieved September 4, 2015 from www.webmd.com
Kelly, C.P. & Lamont, J.T. (2015.) Clostridium difficile in adults: Treatment
in Calderwood, S.B. (Ed.), UpToDate. Waltham, Mass: UpToDate. Retrieved
September 1, 2015 from www.uptodate.com
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