(精选)SCOTTISH ANTIMICROBIAL PRESCRIBING GROUP (SAPG) 2008教学课件.pptVIP

Guidance for Proven or Suspected C. difficile associated diarrhoea (CDAD) Your patient is in a healthcare facility or has been admitted with new onset of DIARRHOEA 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 Prolonged recent hospital stay 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 Stop PPI Stop anti-microbial 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