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| {{Family tree/start}} | | {{Family tree/start}} |
| {{familytree | | | | | | | | | | | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|-|.| | | | | | | | | | | | | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | D01 | | | | | | | | | | | | D02 | | | | | | | | | | | | | | | | | | | D01=Yes | D02=No}}
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| {{familytree | | | | | | | | | | | | | |!| | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | E01 | | | | | | | | | | | | E02 | | | | | | | | | | | | | | | | | | | | | E01=❑ Isolate the patient <br> ❑ Discontinue non-C.Difficle treatment antibiotics <br> ❑ [[Intravenous fluids]] OR [[Oral rehydration therapy]] based upon hydration status <br> ❑ Appropriate attention to infection prevention and control <br> ❑ Emperical antibiotic ([[Metronidazole]] OR [[vancomycin]] based on clinical severity) <br> ❑ Hand hygiene and barrier precautions <br> ❑ Single-use disposable equipment should be used<br> | E02= ❑ [[Intravenous fluids]] OR [[Oral rehydration therapy]] based upon hydration status <br> ❑ Review further inciting antibiotic and other drug history and risk factors for CDI }}
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| {{familytree | | | | | | | | | | | | | |!| | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | |!| | | | | | | | | | | | | F02 | | | | | | | | | | | | | | | | | | | F02=Hospital approval/affordable for Nucleic acid amplification tests (NAATs) for C. difficile toxin}}
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| {{familytree | | | | | | | | | | | | | |!| | | | | | | |,|-|-|-|-|-|^|-|-|-|-|-|.| | | | | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | |!| | | | | | | G01 | | | | | | | | | | G02 | | | | | | | | | | | | | G01=Yes | G02=No}}
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| {{familytree | | | | | | | | | | | | | |!| | | | | | | |!| | | | | | | | | | | |!| | | | | | | | | | | | | |}} | | {{familytree | | | | | | | | | | | | | |!| | | | | | | |!| | | | | | | | | | | |!| | | | | | | | | | | | | |}} |
| {{familytree | | | | | | | | | | | | | |!| | | | | | | |!| | | | | | | | | | | H01 | | | | | | | | | | | | | H01= Fecal glutamate dehydrogenase (GDH) screening tests for C. difficile}} | | {{familytree | | | | | | | | | | | | | |!| | | | | | | |!| | | | | | | | | | | H01 | | | | | | | | | | | | | H01= Fecal glutamate dehydrogenase (GDH) screening tests for C. difficile}} |
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| {{familytree | | | | | | | | | | | | | | | | | | | |`|-|-|-|-|-|v|-|-|-|^|-|-|-|'| | | | | | | | | | | | | | }} | | {{familytree | | | | | | | | | | | | | | | | | | | |`|-|-|-|-|-|v|-|-|-|^|-|-|-|'| | | | | | | | | | | | | | }} |
| {{familytree | | | | | | | | | | | | | | | | | | | | | | | | | R01 | | | | | | | | | | | | | | | | | | | | | R01=Rx for CDI}} | | {{familytree | | | | | | | | | | | | | | | | | | | | | | | | | R01 | | | | | | | | | | | | | | | | | | | | | R01=Rx for CDI}} |
| {{familytree | | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | | | | | | | | | | | | | R01 | | | | | | | | | | | | | | | | | | | | | R01= ❑ Isolate the patient <br> ❑ Discontinue non-C.Difficle treatment antibiotics <br> ❑ Stop all anti-peristaltic agents <br> ❑ [[Intravenous fluids]] OR [[Oral rehydration therapy]] based upon hydration status <br> ❑ Appropriate attention to infection prevention and control <br> ❑ Hand hygiene and barrier precautions <br> ❑ Single-use disposable equipment should be used<br> }}
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| {{familytree | | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | | | | | | | | | | | | | R01 | | | | | | | | | | | | | | | | | | | | | R01=Assessment of severity}}
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| {{familytree | | | | | | | | | | | | | | | |,|-|-|-|-|-|-|-|-|-|+|-|-|-|-|-|-|-|-|-|.| | | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | | | S01 | | | | | | | | S02 | | | | | | | | S03 | | | | | | | | | | | S01=<div style="float: left; text-align: left; line-height: 150% "> '''Any of the following:'''
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| ❑ Admission to intensive care unit for CDI <br> ❑ [[Hypotension]] with or without required use of vasopressors <br> ❑ Fever ≥20.5 °C <br> ❑ [[Ileus]] or significant abdominal distention <br> ❑ Mental status changes <br> ❑ Serum lactate levels >2.2 mmol/l <br> ❑ WBC ≥35,000 cells/mm3 or <2,000 cells/mm3 <br> ❑ End organ failure ([[mechanical ventilation]], [[renal failure]], etc.) </div> | S02= ❑[[Serum albumin]] <3g/dl
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| '''Plus''':
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| Any '''ONE''' of the following:<br>
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| ❑ WBC ≥15,000 cells/mm3 <br>
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| ❑ Abdominal tenderness <br>| S03= [[Diarrhea]] plus any additional signs or symptoms not meeting severe or complicated criteria}}
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| {{familytree | | | | | | | | | | | | | | | |!| | | | | | | | | |!| | | | | | | | | |!| | | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | | | S01 | | | | | | | | S02 | | | | | | | | S03 | | | | | | | | | | | S01=Severe and complicated | S02= Severe | S03=Mild-moderate}}
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| {{familytree | | | | | | | | | | | |,|-|-|-|^|-|-|-|.| | | | | |!| | | | | | | | | |!| | | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | S01 | | | | | | S04 | | | | S02 | | | | | | | | S03 | | | | | | | | | | | | S01= Significant abdominal distention| S04 = No significant abdominal distention | S02= Oral [[vancomycin]] 125 mg QID X 10 days | S03= Oral [[metronidazole]] 500 mg TID X 10 days}}
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| {{familytree | | | | | | | | | | | |!| | | | | | | |!| | | | | |!| | | | | | | | | |!| | | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | |!| | | | | | | S04 | | | | |!| | | | | | | | | S03 | | | | | | | | | | | | S04=❑ Oral vancomycin 125 mg QID <br> '''Plus'''<br> ❑ Intravenous metronidazole 500 mg TID <br>
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| ❑ [[CT]]<br> ❑ [[Deep vein thrombosis primary prevention|Venous thromboembolism (VTE) prophylaxis]]| S02= Severe | S03= Any '''ONE''' of the following:
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| ❑ Failure to respond to metronidazole therapy within 5–7 days <br>
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| ❑ Intolerant/allergic to metronidazole <br>
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| ❑ Pregnant/breastfeeding women}}
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| {{familytree | | | | | | | | | | | |!| | | | | |,|-|^|-|.| | | |!| | | | | | | | | |!| | | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | S01 |-|-|-| S04 | | S05 | | |!| | | | | | | | | S03 | | | | | | | | | | | S01= ❑ Oral vancomycin 500 mg QID <br> '''Plus'''<br> ❑ Vancomycin per rectum (500 mg in a volume of 500 ml QID) <br> '''Plus'''<br> ❑ Intravenous metronidazole 500 mg TID <br>
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| ❑ [[Deep vein thrombosis primary prevention|Venous thromboembolism (VTE) prophylaxis]]| S04= CT showing colon wall thickening, ascites, “megacolon”, ileus, or perforation | S05= CT normal | S02= Severe | S03= ❑ Oral [[vancomycin]] 125 mg QID X 10 days <br> '''OR''' <br> ❑ Oral [[fidaxomicin]] 200 mg BD X 10 days) }}
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| {{familytree | | | | | | | | | | | |!| | | | | |!| | | |!| | | |!| | | | | | | | | |!| | | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | |`|-|-|-|-|-|+|-|-|-|'| | | |!| | | | | | | | | |!| | | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | | | | | T01 | | | | | | |!| | | | | | | | | |!| | | | | | | | | | | | | T01=Surgical consultation and operative management in required cases}}
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| {{familytree | | | | | | | | | | | | | | | | | |`|-|-|-|-|-|-|-|+|-|-|-|-|-|-|-|-|-|'| | | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | | | | | | | | | | | | | U01 | | | | | | | | | | | | | | | | | | | | | U01= ❑Monitor patient status <br> ❑Complete the antibiotic course <br> ❑ Discharge when completely recovered <br> ❑Disinfection of environmental surfaces using an Environmental Protective Agency (EPA)-registered disinfectant}}
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| {{familytree | | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | | | | | | | | | | | | | U01 | | | | | | | | | | | | | | | | | | | | | U01='''First recurrence'''
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| ❑ Confirm diagnosis as above}}
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| {{familytree | | | | | | | | | | | | | | | | | | | |,|-|-|-|-|-|^|-|-|-|-|-|.| | | | | | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | | | | | | | U02 | | | | | | | | | | U03 | | | | | | | | | | | | | | | U02=Severe | U03= Mild-moderate}}
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| {{familytree | | | | | | | | | | | | | | | | | | | |!| | | | | |,|-|-|-|-|-|^|-|-|-|-|-|.| | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | | | | | | | |!| | | | | U04 | | | | | | | | | | U05 | | | | | | | | | | | | | U04= Initial vancomycin regimen | U05 = Intial metronidazole regimen}}
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| {{familytree | | | | | | | | | | | | | | | | | | | |!| | | | | |!| | | | | | | | | | | |!| | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | | | | | | | U01 | | | | U02 | | | | | | | | | | U03 | | | | | | | | | U01 = ❑Tapered and pulsed vancomycin regimen
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| Oral vancomycin 125 mg QID, followed by 125 mg daily pulsed every 3 days for ten doses X 10 days | U02= ❑Tapered and pulsed vancomycin regimen
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| Oral vancomycin 125 mg QID, followed by 125 mg daily pulsed every 3 days for ten doses X 10 days | U03=❑ Oral [[metronidazole]] 500 mg TID X 10 days <br> '''OR'''<br> ❑ Oral vancomycin 125 mg QID X 10 days }}
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| {{familytree | | | | | | | | | | | | | | | | | | | |`|-|-|-|-|-|^|-|-|-|v|-|-|-|-|-|-|-|'| | | | | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | U01 | | | | | | | | | | | | | | | | | U01='''Second recurrence'''
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| ❑ Confirm diagnosis as above<br>
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| ❑ Pulsed vancomycin regimen}}
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| {{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | U01 | | | | | | | | | | | | | | | | |U01='''Third recurrence'''
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| ❑ Confirm diagnosis as above<br>
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| ❑ Pulsed vancomycin regimen<br>
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| ❑ Fecal microbiota transplant trail}}
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| {{familytree/end}} | | {{familytree/end}} |