Clostridioides difficile Infection: Overview, Laboratory Tests, and Updated Guidelines
Continuing Education Credits
This course discusses the characteristics and properties of the Clostridiodes difficile bacterium; its presence in the intestinal tract, toxins A and B, and the aggressive 027 strain. Health care facts and statistics, signs and symptoms, and causes, risk factors, and complications of Clostridiodes difficile infections (CDI) are covered.
You will be introduced to the treatments and prevention of CDI and discuss the most effective antibiotic treatments along with commercially available laboratory tests for CDI. The latest updated IDSA/SHEA guidelines and recommendations on the multistep algorithm for the diagnosis, laboratory testing, and treatment of CDI are also discussed.
Objectives
- Discuss the characteristics and properties of the Clostridioides difficile bacterium to include its presence in the intestinal tract, toxins A and B, and the aggressive 027 strain.
- Describe the health care facts and statistics on Clostridioides difficile infection (CDI).
- Recognize the symptoms and severity of CDI.
- Differentiate mild to moderate, severe, fulminant and recurrent CDIs.
- Identify the causes, risk factors, and complications of CDI.
- Describe the treatment and prevention of CDI.
- Discuss the differential diagnosis of CDI and the various types of laboratory tests available.
- Explain the commercially available laboratory tests for CDI.
- Explain the commercially available laboratory tests for CDI.
- Explain the commercially available laboratory tests for CDI.
Course Outline
- Clostridioides difficile Infection
- Clostridioides difficile: The Bacterium
- Clostridioides difficile Strains and Toxins
- Emerging New Clostridioides difficile Strain: The 027 Strain
- Which of the following statements related to Clostridioides difficile is false?
- Pathogenic C diff strains can produce multiple toxins. Which statement is true regarding these toxins?
- True or False: A hypervirulent strain, commonly referred to as strain 027 is an aggressive strain of Clostridioides difficile that produces more toxins and is more resistant to certain medications.
- CDI: Health Care Facts and Statistics
- CDI: Healthcare Facts and Statistics
- CDI: Symptoms and Severity
- CDI: Symptoms and Severity
- CDI: Symptoms and Severity, continued
- CDI: Symptoms and Severity, continued
- Using white blood cell counts and creatinine levels may help clinicians classify the severity of CDI. If the white blood cell count is ≤15 × 103/µL and serum creatinine <1.5 mg/dL, these results may indicate what classification of CD severity?
- True or False: The risk of a recurrence of CDI is usually higher if the individual is older than 65 and taking other antibiotics while being treated for CDI.
- True or False: Fulminant CDI is characterized by a severe infection associated with complications such as dehydration, hypotension or shock, kidney failure, and other conditions.
- CDI: Causes, Risk Factors, and Complications
- CDI: Causes, Risk Factors, and Complications
- CDI: Risk Factors for CDI
- CDI: Complications of CDI
- Which statement is true relative to the cause of CDI?
- True or False: Taking or having recently taken antibiotics is not considered a risk factor for CDI, but staying in a healthcare facility is considered a risk factor.
- CDI: Treatment and Prevention
- CDI: Treatment
- CDI: Prevention
- Which statement is false relative to the treatment of CDI?
- Diagnosis of CDI: Laboratory Methods
- Diagnosis of CDI: Overview and Challenges
- Diagnosis of CDI: Overview and Challenges, continued
- Diagnosis of CDI: Laboratory Methods
- Diagnosis of CDI: Laboratory Methods, continued
- Diagnosis of CDI: Laboratory Methods, continued
- True or False: Laboratory-based tests to help diagnose CDI typically examine a serum or blood sample for certain toxins and/or specific enzyme antigen produced by the C diff bacteria.
- True or False: One of the challenges in the diagnosis of CDI is stool specimens. C diff toxins are considered heat-labile and are only considered stable for approximately 4 hours at room temperature.
- Match the laboratory method with the method description.
- Laboratory Methods: Overview of Diagnostic Approach
- Laboratory Methods: Diagnostic Approach
- True or False: CDI should be suspected in a patient with acute diarrhea (≥3 loose stools in 24 hours) with no obvious explanation for diarrhea, especially with risk factors.
- Which statement is false when discussing the approach to diagnosing CDI?
- CDI: Commercially-Available Laboratory Tests
- Commercially Available Tests: Overview
- Commercially Available Tests: The Xpect® C Difficile Test
- The Xpect® C. Difficile Toxin A/B Test, continued
- The Xpect® C. Difficile Toxin A/B Test, continued
- True or False: Commercially available testing for CDI currently favors the employment of a rapid, technologically simple, and low-cost assay.
- Which of the following statements is false related to the Xpect® C difficile Toxin A/B test?
- Commercially Available Tests: The C. DIFF QUIK CHEK COMPLETE®
- The C. DIFF QUIK CHEK COMPLETE®, continued
- The C. DIFF QUIK CHEK COMPLETE®, continued
- The C. DIFF QUIK CHEK COMPLETE®, continued
- Which of the following statements related to the C. DIFF QUIK CHEK COMPLETE® test is false?
- A C. DIFF QUIK CHEK COMPLETE® test result showed vertical blue lines on both the "Ag line" and "Toxin line" with a vertical dotted blue line on the "control line." What do these results mean?
- Updated Guidelines and Recommendations
- Overview and summary of IDSA/SHEA guidelines
- Updated IDSA/SHEA Guidelines/Recommendations: Multistep Algorithm Diagnostic Testing and Treatment Recommendations
- Which of the following is not a key change included in the newly updated IDSA and SHEA guidelines for the diagnosis and treatment of CDI?
- Which of the following options is not a recommendation included in the IDSA/SHEA guidelines on diagnostic testing for CDI?
- References
- References
Additional Information
Level of Instruction: Intermediate
Intended Audience: Medical laboratory scientists, medical laboratory technicians, laboratory supervisors, and laboratory managers. This course is also appropriate for MLS and MLT students and pathology residents.
Author Information: David J. Moffa, PhD, BCLD, has over 30 years of experience in the healthcare industry as an executive manager, clinical laboratory director, and medical laboratory scientist. He is currently a technical consultant for Kentmere Healthcare, Wilmington, DE, and until his retirement, was the Regional Director for LabCorp, Inc. He holds a PhD in medical biochemistry from the School of Medicine, West Virginia University.
Reviewer Information:
Lorna Ruskin, EdD, MLS(ASCP), is an Assistant Professor for the Medical Laboratory Science program at the University of Minnesota. Lorna has approximately 20 years of teaching experience in Medical Laboratory Science programs and has served as both the Program Director and Clinical Coordinator. She has done extensive research on laboratory simulation and has presented at national conferences regarding that topic.
Joshua J. Cannon, MS, MLS(ASCP)CMSHCM received his Bachelor
of Science and Master of Science in Medical Laboratory Science from Thomas
Jefferson University in Philadelphia, PA. He holds Medical Laboratory Scientist
and Specialist in Hematology certifications through the ASCP Board of
Certification. He was a professor at Thomas Jefferson University for seven
years before transitioning into his current role as Education Developer at
MediaLab by Vastian. His areas of expertise and professional passions include
clinical hematology and interprofessional education.
Course Description: This course is intended to provide a detailed description of the pathogenesis of the Clostridioides difficile infections, including details of the bacterium, health care statistics, symptoms, severity, risk factors, and complications. The course also discusses the various types of Clostridioides difficile infections and how the treatment and prevention strategies may vary based on the type of infection. Finally, the available laboratory tests used for identification are detailed.