Thread by @halesj126

@MondayNightIBD @Spencerkelley7 1/

👋 to this week’s #MondayNightIBD with the #Back2Basics #B2B team

🦠 Today we are discussing #Cdifficile infection in #IBD

Stay tuned to 📝 more about #CDI :
➡️ #IBD vs. general 👩👨‍🦱
➡️ diagnosis
➡️ treatment options

@MondayNightIBD @Spencerkelley7 @dunleavy_katie @SanjeevaniTomar @yaransarkis @RomyChamoun @BassiMehak @JosephHabibi_MD @DCharabaty @DSTEINGIMD @BeniwalPatelMD 2/

#CDI in #IBD compared to general 👩👨‍🦱

⬆️⬆️ common (5-8x 🔺)
⬆️ community-acquired
⬆️ w/o antibiotic 💊 exposure
⬆️ colonization
⬆️⬆️ recurrence ☹️
⬆️ colectomy risk 🔪

🚨 often no pseudomembranes on 🔦
🚨 can happen post-colectomy 🔪 in #smallbowel or #IPAA

@MondayNightIBD @Spencerkelley7 @dunleavy_katie @SanjeevaniTomar @yaransarkis @RomyChamoun @BassiMehak @JosephHabibi_MD @DCharabaty @DSTEINGIMD @BeniwalPatelMD 3/

Testing for #CDI ⬇️

💩 GDH:
✅ detects organism
⬆️ sensitive
⬇️ specific

💩 PCR:
✅ detects genes that code for toxin
🚫 detect toxin
⬆️ sensitive
⬆️ specific
🚨 can over-diagnose

💩 EIA for toxin A/B:
✅ detects toxin
⬆️ specific
⬇️ sensitive
🚨 can under-diagnose

@MondayNightIBD @Spencerkelley7 @dunleavy_katie @SanjeevaniTomar @yaransarkis @RomyChamoun @BassiMehak @JosephHabibi_MD @DCharabaty @DSTEINGIMD @BeniwalPatelMD 4/

🤔 about diagnosis?

🥇Start with ⬆️ sensitive test (GDH or PCR)
➖ not #CDI
➕ do ⬆️ specific test (toxin EIA)

🥈 Toxin EIA
➕ #CDI confirmed
➖ is 1/3 scenarios:

🟤 colonization
🟤 false ➖ toxin EIA
🟤 early infection

🤔 PCR if GDH ➕ and toxin EIA ➖

@MondayNightIBD @Spencerkelley7 @dunleavy_katie @SanjeevaniTomar @yaransarkis @RomyChamoun @BassiMehak @JosephHabibi_MD @DCharabaty @DSTEINGIMD @BeniwalPatelMD 5/

#CDI severity classification:

Non-severe:
🧫 WBC <15k
➕
🧫 Cr <1.5

Severe:
🧫 WBC >15k
OR
🧫 Cr >1.5

Fulminant:
🧫 severe criteria
➕
Any ⬇️
🧫 🔻 BP
🧫 ileus
🧫 megacolon 🧲