Clostridioides difficile Infection
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Benign Disease- A 55-year-old man presents with severe refractory ulcerative colitis. He was admitted to the hospital and placed on parenteral steroids. He is now receiving salvage therapy with infliximab, but is not responding. The best next step in management is to:
- A 43-year-old man is seen on an inpatient consultation basis for ulcerative colitis that has been recalcitrant to medical management for the past 2 weeks. He has worsening abdominal pain, persistent diarrhea, rectal bleeding, and intermittent fevers. He was given empiric broad-spectrum antibiotics for elevated leukocytosis. Colonoscopy revealed pancolitis consistent with findings of ulcerative colitis. Although his pain improves, he continues to have 15 to 20 watery bowel movements per day. What is the most appropriate next step in management?
- A 56-year-old woman with a history of recurrent urinary tract infections presents to the emergency department with tachycardia (heart rate 124 beats/min), hypotension (blood pressure 85/38 mm Hg), diffuse abdominal pain, and frequent watery diarrhea following a course of oral antibiotics. Her abdomen is distended and diffusely tender. Her white blood cell count is 25,000/L (25109/L) and her hemoglobin is 15.0 g/dL (150 g/L). The patient is positive for Clostridioides difficile and is not responding to treatment with 125 mg of oral vancomycin. What is the next best option for this patient?
- A 68-year-old woman developed crampy abdominal pain with diarrhea after taking antibiotics for a dental procedure. She was treated for Clostridioides difficile infection (CDI) with oral vancomycin. Three weeks later, she developed similar symptoms and is treated for a relapse of CDI with vancomycin for 2 weeks. She now presents with her third episode of CDI 8 weeks after her initial infection. She is hemodynamically stable with minimal abdominal discomfort. She does not want to have surgery and would like to know other alternatives. What is the best next step in management?
- A 66-year-old woman presents to the emergency department with loose, watery stools for 3 days, after completing a 10-day course of oral antibiotics for a sinus infection. The patient denies nausea or vomiting. A stool sample is positive for Clostridioides difficile toxin. Examination reveals soft, nondistended, and mild lower abdominal tenderness. The best next step in management is:
- A 23-year-old man with a history of ulcerative colitis is admitted to the hospital with bloody diarrhea. His white blood cell count is 13,000/L (13109/L) and hemoglobin is 8.3 g/dL (83 g/L). He is hemodynamically stable. After hospital admission and initiation of intravenous (IV) steroids and infliximab, he undergoes flexible sigmoidoscopy with biopsy. He continues to have 10 to 12 bloody bowel movements daily. Endoscopic and pathologic findings are shown (Figures 1 and 2). What is the best next step in management?