Clostridium Difficile Infection

Clinical Presentation: Abdominal pain, diarrhea, leukocytosis, recent antibiotic use

Common Treatments: Oral metronidazole; if refractory, oral vancomycin

Spore-forming bacteria (Page 127)
Some bacteria can form spores at the end of the stationary phase when nutrients are limited. Spores are highly resistant to heat and chemicals. Have dipicolinic acid in their core. Have no metabolic activity. Must autoclave to potentially kill spores (as is done to surgical equipment) by steaming at 121°C for 15 minutes.

Nosocomial Infections (Page 181)
E coli (UTI) and S aureus (wound infection) are the two most common causes.
Risk Factor: Antibiotic use
Unique Signs/Symptoms: Watery diarrhea, leukocytosis

Vancomycin (Page 186) 
Mechanism: Inhibits cell wall peptidoglycan formation by binding D-ala D-ala portion of cell wall precursors. Bactericidal against most bacteria (bacteriostatic against C difficile). Not susceptible to β-lactamases. 
Clinical Use: Gram ⊕ bugs only—serious, multidrug-resistant organisms, including MRSA, S epidermidis, sensitive Enterococcus species, and Clostridium difficile (oral dose for pseudomembranous colitis).
Adverse Effects: Well tolerated in general—but NOT trouble free. Nephrotoxicity, Ototoxicity, Thrombophlebitis, diffuse flushing—red man syndrome (largely preventable by pretreatment with antihistamines and slow infusion rate).